Annual radiographs of hands, feet, and cervical spine were taken in 100 patients with rheumatoid arthritis from the first year of disease for a mean follow-up period of 9.5 years. Seventy-six patients developed peripheral erosive disease and 54 developed rheumatoid changes of the cervical spine, of whom 34 (63%) had subluxations. The severity of rheumatoid neck damage correlated strongly with the severity of peripheral erosive disease (p = 0.002). Cervical subluxation was more likely to occur in patients with erosions of the hands and feet which deteriorated progressively with time (p = 0.018). The timing and severity of cervical subluxation coincided with the progression of peripheral erosive disease in 26 of these 34 patients (76.5%). The other 8 patients with cervical subluxation (23.5%) had none or only mild peripheral erosions, but their subluxations did not progress with time. There were 9 patients with marked cervical subluxations which deteriorated relentlessly, and they all also had severe progressive erosive disease of the hands and feet. One of these patients developed a cervical myelopathy, and 2 other patients with normal neurological signs had upper cervical fusions performed for severe occipital headache. This small group of rheumatoid patients who are at risk of developing cervical myelopathy cannot be predicted with certainty, but can be selected out at an early stage by performing regular radiographs of hands, feet, and cervical spine.
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