What is the prevalence of rheumatoid arthritis (RA) of the cervical spine?

Updated: Aug 13, 2019
  • Author: Steven R Garfin, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Numerous investigators have attempted to elucidate the natural history of rheumatoid arthritis (RA) as it affects the cervical spine, with wide variation in their findings. [7, 8, 9, 10, 11]

Of the 0.8% of the white population in the United States and Europe affected by RA, neck pain is reported in 40-88% of patients. The prevalence of cervical spine involvement in RA ranges from 25% to 80%, depending on the diagnostic criteria applied. [12] However, only 7-34% of patients with RA have a neurologic deficit. A substantial number of patients with radiographic instability or neck pain do not develop neurologic deficits. [13]

Involvement of the cervical spine typically begins early in the disease process and often parallels the extent of peripheral disease. Of the 3 types of involvement, atlantoaxial instability (AAI) is the most common, occurring in up to 49% of patients. [14] Most of these subluxations are anterior, while approximately 20% are lateral and approximately 7% are posterior. Superior migration of the odontoid (SMO) is seen in up to 38% of patients with RA. Subaxial subluxation is seen as a discrete pathologic entity in 10-20% of patients.

A meta-analysis of 2750 patients with RA found that the following are significant risk factors for cervical spine involvement in in RA [15] :

  • Female sex
  • Positive rheumatoid factor
  • Long‐term corticosteroid treatment
  • Peripheral joint erosions
  • Younger age
  • Long duration of RA
  • Markers of higher disease activity (ie, elevated erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, Disease Activity Score [DAS])

Subaxial subluxation (SAS) also develops after previous upper cervical fusions. [16] In one series of 25 patients, 48% developed SAS following atlantoaxial fusion. However, further surgery was not needed for SAS up to 5 years after the initial surgery. [17]  

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