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THU0154 Atlantoaxial disorders in rheumatoid arthritis associate with destructions of the peripheral and shoulder joints, and decreased bone mineral density
  1. MH Neva1,
  2. A Kotaniemi2,
  3. K Kaarela2,
  4. JT Lehtinen3,
  5. P Isomäki2,
  6. EA Belt3,
  7. H Kautiainen2,
  8. M Kauppi2
  1. 1Department of Surgery, Tampere University Hospital, Tampere
  2. 2Department of Rheumatology
  3. 3Department of Orthopaedic Surgery, Rheumatism Foundation Hospital, Heinola, Finland


Background Anterior atlantoaxial subluxation (aAAS) and atlantoaxial impaction (AAI) are common cervical spine disorders in advanced rheumatoid arthritis (RA;1). Earlier studies have suggested the association of the cervical spine disorders with peripheral joint destruction and osteoporosis of the cervical spine.

Objectives To evaluate whether atlantoaxial disorders (aAAS and AAI) associate with destruction of shoulder- (glenohumeral [GH] or acromioclavicular [AC]) or peripheral joints, and bone mineral density (BMD) in patients who have suffered RA for 20-years.

Methods An inception cohort of 103 patients with rheumatoid factor (RF) positive RA were followed up for 20 years, a total of 68 patients attended the 20-year check-up.1 The shoulder radiographs were taken at the 15-year examination, and the cervical spine, hand and foot radiographs at the 20-year follow-up. Moreover, the BMD of the lumbar spine and femoral neck were measured at the 20-year check-up. Thereafter, the occurrence and severity of atlantoaxial disorders were compared with the Larsen scores of peripheral and shoulder (GH and AC) joints, and with BMD of the lumbar spine and femoral neck.

Results A positive relationship was detected between the occurrence of atlantoaxial disorders and the destruction of both shoulder (p < 0.001) and peripheral (p = 0.001) joints. In addition, the extent of aAAS and the severity of AAI correlated positively with the grade of destruction in the evaluated joints. Furthermore, a positive relationship was found between the occurrence of the atlantoaxial disorders and a decrease in BMD of the lumbar spine (p = 0.13) and femoral neck (p = 0.019).

Conclusion Patients with severe RA have an increased risk for atlantoaxial disorders, and the co-existence of shoulder and cervical spine disorders makes the differential diagnosis of shoulder and neck pain challenging. In addition, osteoporosis may increase the risk for severe complications caused by cervical spine disorders in patients with RA.


  1. Neva MH, Kaarela K, Kauppi M. Prevalence of radiological changes in the cervical spine – a cross-sectional study after 20 years from presentation of rheumatoid arthritis. J Rheumatol. 2000;27:90–3

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