In early disease, many patients have cervical pain, which may be due to muscle spasm. During the course of their disease up to 90% of RA patients have some cervical spine involvement, and it is particularly common in long-standing disease and multiple joint involvement. Significant subluxations occur in about one-third of cases.
As neurological deterioration can be irreversible, it is important to look for subtle signs of early neurological involvement. In addition to painful limitation of neck motion, warning signs of cervical involvement in RA include:
♦ suboccipital pain;
♦ paresthesiae in the hands and feet;
♦ urinary retention or incontinence;
♦ involuntary leg spasms;
♦ evidence of upper motor neuron lesions in the legs or arms.
Common radiological presentations include atlanto-axial subluxation (the most common sign) and atlanto-axial impaction (also called basilar invagination). Such patients should have an MRI of the cervical spine to highlight other features, such as pannus of the odontoid peg and cord compression
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