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THU0199 Rheumatoid arthritis: the correlation between destruction of dens ephistrophei and sex, rheumatoid factor presence and steinbrocker´s grade of the hands and the feet
  1. M Vesela,
  2. L Sedova,
  3. J Gatterova,
  4. M Olejarova,
  5. Z Seidl,
  6. K Pavelka
  1. Clinic of Rheumatology, Institute of Rheumatology, Prague, Czech Republic

Abstract

Objectives To find correlation between destruction of dens ephistrophei and rheumatoid factor presence, sex, Steinbrocker´s grade of hands and the feet.

Methods A computer analysis of 4,691 patients with polyarthritis from the database of the Institute of Rheumatology over the 2 years period (from 1998–12–01 till 2000–11–30) was done.

Totally 860 patients had X ray examinations made for the neck pain, the cervicocranial and/or the cervicobrachial syndrome. The X ray examinations of the cervical spine were made in the static and dynamic projections and were evaluated by the same radiologist. The diagnosis of RA was established in 286 cases according to ACR criteria. A group of 139 patients without radiological evidence of the cervical spine involvement was used as the control group. The rheumatoid factor (RF) was detected by the ELISA method. The X ray examinations of the hands and of the feet in the classical projection were classified according to Steinbrocker.

A computer analysis of 4,691 patients with polyarthritis from the database of the Institute of Rheumatology over the 2 years period (from 1998–12–01 till 2000–11–30) was done.

Totally 860 patients had X ray examinations made for the neck pain, the cervicocranial and/or the cervicobrachial syndrome. The X ray examinations of the cervical spine were made in the static and dynamic projections and were evaluated by the same radiologist. The diagnosis of RA was established in 286 cases according to ACR criteria. A group of 139 patients without radiological evidence of the cervical spine involvement was used as the control group. The rheumatoid factor (RF) was detected by the ELISA method. The X ray examinations of the hands and of the feet in the classical projection were classified according to Steinbrocker.

Results Patients with polyarthritis (n = 860) had the X ray examinations of the cervical spine for the neck pain (68%), cervicocranial syndrome (29%) or cervicobrachial syndrome (3%). Radiological evidence of the cervical involvement was found in 147 patients with RA out of 286. Atlantoaxial subluxation (AAS) was found in 109 patients (74.15%), destruction of the dens in 48 (32.65%). The AAS and coincidental dens destruction was present in 20 patients (13.61%) out from 147. The vertical and lateral subluxations was found only in the combinations with the ventral subluxations: ventral and vertical in 6 cases, ventral and lateral in 3 cases.

There were found positive correlations of the presence of any type of cervical spine involvement with the radiographic stage of the hands (X2 = 86.51; p < 0.0001) and of the feet (X2 = 43,33; p < 0.0001) and also of the dens destruction and the radiographic stage of RA of the hands (X2 = 67,63; p < 0,0001) and of the feet (X2 = 38,84; p < 0,0001). The associations of cervical spine involvement with positive rheumatoid factor, sex were not significant.

Conclusion Destruction of dens ephistrophei correlates both, with the hands and feet radiographic stages; the correlation with the feet involvement was less pronounced. There was no significant difference in cervical spine involvement by sex or rheumatoid factor presence. The vertical and the lateral subluxations were found only in the combinations with the ventral subluxations.

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