How is rheumatoid arthritis (RA) of the cervical spine treated?

Updated: Aug 13, 2019
  • Author: Steven R Garfin, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

Answer

An approach to surgical and nonsurgical management for rheumatoid arthritis and for rheumatoid spondylitis can be developed based on the natural history of rheumatoid involvement of the cervical spine and radiographic predictors of paralysis.

As suggested by Boden, 3 goals should be kept in mind. [47] The first goal is to avoid the development of an irreversible neurologic deficit, as patients with more severe deficits have less recovery and higher morbidity. A second goal is to prevent sudden death from unrecognized neural compression, as has been reported in up to 10% of deaths in rheumatoid arthritis. [18] Finally, as one half of patients with rheumatoid arthritis with radiographic evidence of instability remain asymptomatic, it is best to avoid surgery if the patient can be identified as being one who will most likely not develop neurologic problems.


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