Background RA complications seem less common including vasculitis, nodules, corneal melts and rheumatoid neck involvement with damage.
Objectives The prevalence and progression of anterior atlanto-axial subluxations (aAAS), vertical subluxations (VS), subaxial subluxations (SA) and associated cervical myelopathy in rheumatoid arthritis (RA) over the past 50 years were determined.
Methods A literature search was performed using Medline-OVID/EMBASE, PubMed, and Scopus (from 1960 to June 21, 2014). Prevalence studies were included if the sample size was at least 100 or the prevalence/progression of cervical subluxations was reported. Study quality was assessed using the STROBE checklist. Prevalence of cervical subluxations was calculated for each study. Student's t test and meta-regression was used to evaluate for significance.
Results A total of 12,249 citations were identified with 59 studies included. The prevalence of aAAS decreased from 36% (95%CI: 30%>42%) before 1980s to 24% (95%CI: 13%>36%) in 2000s (p=0.04). The overall prevalence of VS was 11% (95%CI: 10%>19%), 13% (95%CI: 12%>20%) for SA and cervical myelopathy 5% (95%CI: 3%>9%) without significant temporal changes. Rate of progression of aAAS, VS, and SAS subluxations was 4, 6, and 3 lesions per 100 patients per year, respectively. The incidence of new or progressive cervical myelopathy occurred at 2 cases per 100 patients with known cervical subluxations per year. Characteristics of studies (every other study is shown) with progression of C spine lesions in RA:
Conclusions Since the 1960s, only aAAS has decreased dramatically. It is still more than twice as common as VS or SAS. No temporal changes in development of cervical myelopathy in affected RA patients were noted. The progression rate of cervical subluxations and myelopathy was unchanged over time.
Disclosure of Interest None declared