Efficacy of Atlantoaxial Joint Glucocorticoid
Injection in Patients with Rheumatoid Arthritis:
A Randomized Trial

Background: The atlantoaxial joint (AAJ) plays a pivotal role in the cervical spine motion. Unfortunately, it is the most common cervical spine joint that is affected in patients with rheumatoid arthritis. Inflammation of the AAJ results in neck disability, nerve root compression, and finally spinal cord compression. Objectives: We aim to evaluate the efficacy of intraarticular triamcinolone injection of the AAJ on neck pain and disability. Study Design: A prospective randomized, controlled clinical trial. Setting: An interventional pain unit in a tertiary center at a university hospital in Egypt. Methods: Sixty patients with rheumatoid arthritis complaining of AAJ arthritis were randomized into 2 groups. Group AAJI (n = 30) received AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of 20 mg of triamcinolone, in addition to oral placebo tablets (2 tablets every 8 hours for one week). Group SS (n = 30) received systemic steroids, oral prednisolone tablets (5 mg, 2 tablets every 8 hours for one week), in addition to AAJ injection with 1.0 mL of a mixture of 0.5 mL of bupivacaine 0.5% and 0.5 mL of normal saline solution. The percentage of patients who showed ≥ 50% reduction of their visual analog scale (VAS) pain score (measured at 1, 2, and 3 months postoperatively), VAS pain score and neck disability index (NDI) (measured at 2, 4, 6, 8, and 12 weeks postoperatively), and the magnetic resonance imaging (MRI) changes of AAJ (assessed 4 weeks postoperatively) were all evaluated. Results: There was significant reduction in the percentage of patients who showed ≥ 50% reduction of their VAS pain score postoperatively in group AAJI compared with group SS at one month (75% vs. 46.45%; P = 0.033), 2 months (60.7% vs. 25%; P = 0.009), and 3 months (53.6% vs. 17.9%; P = 0.007). There was significant reduction in overall VAS and overall NDI in group AAJI compared with group SS (mean ± standard error) (41.5 ± 2.6 vs. 52.1 ± 2.6; P = 0.005) and (43.7 ± 3.1 vs. 52.4 ± 3.1; P = 0.040), respectively. Analysis of postoperative MRI findings revealed significant improvement of bone marrow edema in group AAJI (AAJI vs. SS) (71.4% vs. 42.9%; P = 0.033), also the synovial enhancement disappeared significantly in group AAJI compared with group SS, (16/22 [72.7%] vs. 10/23 [43.5%]; P = 0.026), moreover, there was a significant reduction in pannus size in group AAJI compared with group SS, (6/10 [60%] vs. 1/9 [11%]; P = 0.041). Limitations: The study follow-up period was limited to only 3 months. Conclusions: For acutely inflamed AAJ due to rheumatoid arthritis, AAJ steroid injection is a potential therapeutic option; it decreased cervical neck pain, improved neck mobility, and hastened recovery of the joint from an acute inflammatory stage. Key words: Rheumatoid arthritis, atlantoaxial joint injection

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THU0453 THIRD OCCIPITAL NERVE RADIO-FREQUENCY UNDER FLUOROSCOPIC GUIDANCE IN MANAGEMENT OF CERVICOGENIC HEADACHE IN RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.241 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 463.2-464

Author(s):

A. Alawamy ◽

M. Hassanien ◽

E. Talaat ◽

E. Kamel

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

Neck Pain ◽

Neck Disability Index ◽

Cervicogenic Headache ◽

Control Group ◽

Fluoroscopic Guidance ◽

Occipital Nerve ◽

Nocturnal Pain ◽

Neck Disability

Background:Rheumatoid arthritis is a common type of autoimmune arthritis characterized by chronic inflammation. Cervical spine is often affected specially in long lasting diseaseObjectives:Evaluate efficacy of Third occipital nerve Radiofrequency under fluoroscopic guidance to treat refractory cervicogenic headache in RA patients.Methods:The current study was revised and approved from the local ethical committee of Faculty of Medicine; Assiut University, then registered in the clinical trials under the number ofNCT03852355. Inclusion criteria included, Patients who fulfilled the American College of Rheumatology (ACR) (2010) criteria for RA and suffering from upper neck pain and/or headache due to bilateral 3rd occipital nerve involvement, excluding other local cervical spine pathologies was confirmed by MRI and previously failed conservative treatment for at least three months prior to enrollment. Sixty adult patients were randomly assigned to one of the two studied groups Group 1 (RF, n = 30), received bilateral Third occipital nerve Radiofrequency under fluoroscopic guidance or Group 2 (control group, n = 30), received oral prednisolone 10 mg/day. The two groups were then followed-up with neck disability index (NDI), nocturnal neck pain VAS score and headache score every two weeks for three months. Sleep disturbance, sleep disability index were reassessed six months post intervention. Post interventional assessment was done by pain physician who were kept blind to the grouping process.Results:Neck disability index (1ry outcome), Nocturnal pain VAS, and severity of headache showed significant differences during the whole post-interventional study period. The patients in RF group demonstrated significant improvement of pain in comparison to baseline value over the whole six months with p-value < 0.001 as regard to the fore-mentioned three parameters. On the other aspect, the control group patients showed significant improvement in comparison to its baseline value after the 2nd, 12th and 24th weeks only as follows: (0.001,0.003, 0.003 for the NDI) (p values of 0.02,0.01, 0.01 for the nocturnal pain VAS), (0.001 0.009, 0.005 for the headache VAS severity.Conclusion:Radiofrequency of 3rd occipital nerve is effective in treatment of refractory cervicogenic headache in RA.Disclosure of Interests: :None declared

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Estimating EQ-5D values from the Neck Disability Index and numeric rating scales for neck and arm pain

Journal of Neurosurgery Spine ◽

10.3171/2014.5.spine13570 ◽

2014 ◽

Vol 21 (3) ◽

pp. 394-399 ◽

Cited By ~ 10

Author(s):

Leah Y. Carreon ◽

Kelly R. Bratcher ◽

Nandita Das ◽

Jacob B. Nienhuis ◽

Steven D. Glassman

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Regression Model ◽

Pain Score ◽

Rating Scales ◽

Neck Disability Index ◽

Correlation Coefficients ◽

Arm Pain ◽

Pain Scores ◽

Neck Disability

Object The Neck Disability Index (NDI) and numeric rating scales (0 to 10) for neck pain and arm pain are widely used cervical spine disease–specific measures. Recent studies have shown that there is a strong relationship between the SF-6D and the NDI such that using a simple linear regression allows for the estimation of an SF-6D value from the NDI alone. Due to ease of administration and scoring, the EQ-5D is increasingly being used as a measure of utility in the clinical setting. The purpose of this study is to determine if the EQ-5D values can be estimated from commonly available cervical spine disease–specific health-related quality of life measures, much like the SF-6D. Methods The EQ-5D, NDI, neck pain score, and arm pain score were prospectively collected in 3732 patients who presented to the authors' clinic with degenerative cervical spine disorders. Correlation coefficients for paired observations from multiple time points between the NDI, neck pain and arm pain scores, and EQ-5D were determined. Regression models were built to estimate the EQ-5D values from the NDI, neck pain, and arm pain scores. Results The mean age of the 3732 patients was 53.3 ± 12.2 years, and 43% were male. Correlations between the EQ-5D and the NDI, neck pain score, and arm pain score were statistically significant (p < 0.0001), with correlation coefficients of −0.77, −0.62, and −0.50, respectively. The regression equation 0.98947 + (−0.00705 × NDI) + (−0.00875 × arm pain score) + (−0.00877 × neck pain score) to predict EQ-5D had an R-square of 0.62 and a root mean square error (RMSE) of 0.146. The model using NDI alone had an R-square of 0.59 and a RMSE of 0.150. The model using the individual NDI items had an R-square of 0.46 and an RMSE of 0.172. The correlation coefficient between the observed and estimated EQ-5D scores was 0.79. There was no statistically significant difference between the actual EQ-5D score (0.603 ± 0.235) and the estimated EQ-5D score (0.603 ± 0.185) using the NDI, neck pain score, and arm pain score regression model. However, rounding off the coefficients to fewer than 5 decimal places produced less accurate results. Conclusions The regression model estimating the EQ-5D from the NDI, neck pain score, and arm pain score accounted for 60% of the variability of the EQ-5D with a relatively large RMSE. This regression model may not be sufficient to accurately or reliably estimate actual EQ-5D values.

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A Study to find the effectiveness of Scapular Strengthening Exercise in patients with Cervical Dysfunction

Research Journal of Pharmacy and Technology ◽

10.52711/0974-360x.2021.00621 ◽

2021 ◽

pp. 3591-3594

Author(s):

Kotteeswaran. K ◽

Chiranjibi Kumar Nayak

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Neck Disability Index ◽

T Test ◽

Strengthening Exercise ◽

Significant Difference ◽

Group A ◽

Group B ◽

Neck Disability ◽

Cervical Spine Dysfunction

Background: Cervical spine dysfunction is a cause of neck pain. The cause for it is believed to be a disorder (most likely malalignment) of the pain-sensitive facet joints (which may also be due to disc disruption). Dysfunction can also cause secondary muscle spasm, which can may lead to more pain and stiffness. Objective: To find the effectiveness of SNAGs and scapular strengthening exercises in the patients with chronic cervical dysfunction. To find the Neck disability index (NDI) score difference between the functional activities of experimental group and conventional treatment group. Methodology: According to inclusion and exclusion criteria a prior to the study, the principal researcher explained the procedures to all the subjects and inform consent obtained, 30 subjects taken through Random block design and numbering was done for all the subjects. All the odd numbers in one group and all the even numbers in another group are allocated by random table where each group had 15 subjects. The collected data was tabulated and analyzed using descriptive and inferential statistics. To all parameters mean and standard deviation (SD) were used. Paired t-test was used to analyze significant changes between pre-test and post-test measurements. Unpaired t-test was used to analyze significant changes between two groups. Result: rom statistical analysis made with the quantitative data revealed statistically significant difference between the Group A and Group B, and also within the group. The Posttest mean value of Neck Disability Index (NDI) in group A is 12.00 and in group B is 13.80. This shows that Neck Disability Index (NDI) in Group B disability value were comparatively more than Group A disability value, P<0.0001. Conclusion: This study shows better improvement in reducing cervical spine dysfunction (neck pain) by scapular strengthening exercise than resisted neck isometrics. Both the techniques can be used in clinical practice.

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EFFECT OF 6 WEEKS GREEVA SANCHALAN ON CERVICAL SPINE HEALTH AMONG MALE IT PROFESSIONALS

Scholarly Research Journal for Interdisciplinary Studies ◽

10.21922/srjis.v9i66.6824 ◽

2021 ◽

Vol 9 (66) ◽

pp. 15310-15318

Author(s):

Shankar Khedkar ◽

Pooja Sharma

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Neck Disability Index ◽

Neck Muscles ◽

Control Group ◽

It Professionals ◽

Desktop Computer ◽

Post Test ◽

Neck Disability ◽

And Control

Purpose of present research was to study the effect of 6 weeks Greeva Sanchalan on Cervical Spine Health or work-related neck pain among male IT professionals. Quasi Pre-test Post-test Non-Equivalent research design used to achieve this objective. Non-Probability based Judgemental Sampling Technique, was used to screen samples from 2 different IT firms from Pune city, who were falling under the criteria of using laptop/desktop/computer for ≥5hours/day, between 30-50years of age group, experiencing neck pain/stiffness and were willing to participate in study. Neck Disability Index Questionnaire (NDI) includes 10 measuring sections such as neck pain, personal care, headache, lifting, reading, concentration, sleeping, work, driving, and recreation was used to collecting data. Using ABBA method, total selected 26 IT professionals, were divided into two groups, i.e., experimental (n=13) and control group (n=13). 6 weeks Greeva Sanchalan intervention was developed and implemented to experimental group’s IT professionals only. After 6 weeks, post-test NDI scores were collected for all 26 IT professionals. NDI pre and post test scores were statistically analysed through Descriptive and Inferential statistics using SPSS software. Mean of pre and post NDI scores for experimental group was 7.92 (±1.89) and 5.62 (±1.26) respectively. Similarly Mean of pre and post NDI scores for control group was 7.54 (±2.44) and 7.77 (± 2.98) respectively. On comparing the Mean of pre and post NDI scores with Neck Disability Index standard norms, all 26 IT professionals were falling within mild neck disability category. Mean of change in performance for experimental and control group’s IT professionals were 2.31 (±2.06) and 0.23 (±1.74) respectively. Calculated mean difference of change in performance was 2.54 for 26 IT professionals. Calculated t-value was 3.40(24) at 0.05 significance level (p=0.002; p less than 0.05). According to statistical outcome, 6 weeks Greeva Sanchalan intervention benefitted in reducing neck pain/stiffness related to work among IT professionals, which relieved muscular tension of neck-shoulder region. It improves range of motion (CROM) of cervical pivot joint along with regaining neck muscles flexibility, which also strengthens neck muscles.

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Influence of the cervical spine manipulation in the neck disability index in patients with chronic neck pain: A preliminary study.

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2015.13.283 ◽

2015 ◽

Vol 13 ◽

pp. 283

Author(s):

Iã Ferreira Miranda ◽

Daniel Facchini ◽

Eliane Fátima Manfio

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Sham Group ◽

Neck Disability Index ◽

Chronic Neck Pain ◽

Post Treatment ◽

Group Method ◽

Cervical Spine Manipulation ◽

Pre Treatment ◽

Neck Disability

Background: Neck pain is one of the major problems managed by chiropractors, therefore its common the use of spinal manipulation to manage this problem. Objective: To evaluate the influence of Cervical Spine Manipulation (CSM) in the Neck Disability Index (NDI) of patients with chronic neck pain compared to a manipulative sham group. Method: 15 patients with chronic neck pain, were randomly assigned into one of two groups. Experimental Group (EG), with 8 patients, mean age of 30.6(13.7) years and Sham Group (SG), with 7 patients, mean age of 38.9(17.0) years. All the patients signed a Voluntary Informed Consent Document, approved by the university’s research ethics committee (n°555.015). The NDI was used to evaluate the outcome. The EG intervention was the CSM, performed 4 times, along a mean of 39.2 days. The SG was subjected to a similar cervical manipulative sensory experience, also performed 4 times, along a mean of 30.6 days. Paired and unpaired Student’s t-test was used to assess intra and inter group differences, respectively. Results: Statistically significant differences (p=0.000) were found for NDI between the pre and post-treatment evaluations of both the EG (26.3(5.0) % pre; 10.9(7.1) % post) and the SG (30.1(3.7) % pre; 18.4(5.3) % post). There were no significant differences for NDI in the pre-treatment between groups (p=0.122), however statistically significant differences were found in the post-treatment between the EG and the SG (p=0.039). Conclusion: The result shows that after the treatment period both groups showed improvement for NDI, however the CSM in the EG resulted in an improved outcome in the treatment of patients with chronic neck pain.

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Assessment of the occurrence of pain in the cervical spine and knowledge of physiotherapy and computer science students about Text Neck Syndrome

Medycyna Manualna ◽

10.5604/01.3001.0013.6636 ◽

2019 ◽

Vol XXIII (2) ◽

pp. 15-24

Author(s):

Joanna PIĘTA ◽

Adrian KUŻDŻAŁ ◽

Aleksander ZAGÓRSKI

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Computer Science ◽

Neck Disability Index ◽

Science Students ◽

Spine Pain ◽

Neck Disability ◽

First Time ◽

The Relationship ◽

Cervical Spine Dysfunction

Aim. The aim of the study was to assess the frequency of cervical spine pain and students' knowledge about Text Neck Syndrome. Material and research methodology. The study covered 150 students of Physiotherapy and Computer Science, aged 18 - 26. The study used questionnaire consisting of 24 questions, as well as the NDI (Neck Disability Index) questionnaire. Results. The research have shown, that 69% of respondents have experienced cervical spine pain in their lives. Almost half of the students have heard about Text Neck Syndrome. A relationship between the frequency of neck pain and the age at which neck pain appeared for the first time, physical activity, the number of hours spent using the cell phone and the position taken while using the phone as well as the position taken at work were demonstrated . The relationship between the sum of points obtained in the NDI questionnaire and the number of hours allocated to using a mobile phone was also demonstrated. Conclusions. Most students have experienced cervical spine pain in their lives. Many factors affect the incidence of neck pain. Almost half of the respondents heard about Text Neck Syndrome. The use of cell phones affects the pain and level of cervical spine dysfunction.

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A Novel Virtual Reality Technique (Cervigame®) Compared to Conventional Proprioceptive Training to Treat Neck Pain: A Randomized Controlled Trial

Journal of Biomedical Physics and Engineering ◽

10.31661/jbpe.v9i3jun.556 ◽

2019 ◽

Vol 9 (3Jun) ◽

Cited By ~ 1

Author(s):

I Rezaei ◽

M Razeghi ◽

S Ebrahimi ◽

S Kayedi ◽

A Rezaeian Zadeh

Keyword(s):

Virtual Reality ◽

Visual Analogue Scale ◽

Neck Pain ◽

Analogue Scale ◽

Controlled Trial ◽

Neck Disability Index ◽

Repeated Measure ◽

Balance Test ◽

Proprioceptive Training ◽

Neck Disability

Background: Despite the potential benefits of virtual reality technology in physical rehabilitation, only a few studies have evaluated the efficacy of this type of treatment in patients with neck pain.Objective: The aim of this study was to compare the effects of virtual reality training (VRT) versus conventional proprioceptive training (CPT) in patients with neck pain.Methods: Forty four participants with nonspecific chronic neck pain were randomly assigned to VRT or CPT in this assessor-blinded clinical trial. A novel videogame called Cervigame® was designed for VRT. It comprises of 50 stages divided into unidirectional and two-directional stages ordered from easy to hard. CPT consisted of eye-follow, gaze stability, eye-head coordination and position and movement sense training. Both groups completed 8 training sessions over 4 weeks. Visual analogue scale score, neck disability index and Y-balance test results were recorded at baseline, immediately after and 5 weeks post-intervention. Mixed repeated measure ANOVA was used to analyze differences between mean values for each variable at an alpha level of 0.05.Results: There were significant improvements in all variables in both groups immediately after and 5 weeks after the intervention. Greater improvements were observed in the visual analogue scale and neck disability index scores in VRT group, and the results for all directions in Y-balance test were similar in both groups. No side effects were reported.Conclusion: Improvements in neck pain and disability were greater in VRT than CPT group. Cervigame® is a potentially practical tool for rehabilitation in patients with neck pain.

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Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial

Scandinavian Journal of Pain ◽

10.1515/sjpain-2020-0154 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Zahra Rezasoltani ◽

Hanna Ehyaie ◽

Reza Kazempour Mofrad ◽

Fatemeh Vashaei ◽

Reza Mohtasham ◽

...

Keyword(s):

Neck Pain ◽

Myofascial Pain ◽

Neck Disability Index ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Trigger Points ◽

Double Blind ◽

Upper Trapezius ◽

Disability Scale ◽

Neck Disability

Abstract Objectives Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome. Methods We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale. Results Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups. Conclusions Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.

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SAT0547 RADIOGRAPHIC IMAGING IN ASSESSMENT OF FLUOROSCOPIC GUIDED INJECTION OF RHEUMATOID ATLANTOAXIAL JOINT INFLAMMATION

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1810 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1230.1-1231

Author(s):

D. Fouad ◽

S. Rashad ◽

M. Ghaly ◽

M. Hassanien

Keyword(s):

Rheumatoid Arthritis ◽

Neck Pain ◽

Sleep Quality ◽

Sleep Disturbance ◽

Steroid Injection ◽

Therapeutic Option ◽

Control Group ◽

Atlantoaxial Joint ◽

Post Intervention

Background:Rheumatoid spondylitis is a feature of long-lasting Rheumatoid arthritis (RA) that is presented by neck pain, headache and sleep disturbance. Atlantoaxial joint (AAJ) is the commonest cervical spine joint that affected in patients with RA. When it is involved, it can be associated with dangerous complications. Magnetic Resonance Imaging (MRI) can be used for assessing the disease activity, the amount of cartilage destruction, associated cervical myelopathy and differentiating synovial fluid from inflammatory pannus (Taniguchi D, et al., 2008).Objectives:This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, regarding neck pain, headache and sleep quality using pre and post-interventions MRI.Methods:A prospective case control study. Patients with inflamed AAJ were recruited. Group 1 (AAJ group, n = 30), received intraarticular AAJ steroid injection, guided by fluoroscopy and Group 2 (control group, n = 30), received systemic steroids. Both groups were assessed with: Visual Analogue scale (VAS) for nocturnal neck pain and headache. Pittsburgh sleep quality index (PSQI) was used for sleep disturbance. Pre and post contrasts enhanced MRI interventions were done for both groups during the period of follow up (three months).Results:Nocturnal neck pain, headache and sleep disturbance have significantly decreased, during follow up visits (3 months), in AAJ group in comparison to the control group. The Pre-intervention nocturnal pain score was 60.3 ±17.1 in AAJ group & 58.5 ±17.9 in control group. Pain has significantly decreased after 2weeks in AAJ group with continuous improvement till 3 months’ post-intervention 6.9 ±4.65 & 51.26 ±10.54 respectively. The pre-intervention headache was 22.68 ±16.74 in AAJ group & 45.17 ±15.83 in control group decreased to 7.54 ±5.23 & 48.52 ±11.98 respectively post intervention. The percentage of patients who had sleep disturbance at baseline was 66.7% & 73.3% in AAJ and control groups respectively which has significantly decreased to 6.7% & 43.3% after 3 months. Regarding MRI, AAJ group hada statistical significant decreasein the percentage of patients with MRI synovial enhancement, inflammatorypannus,fibrosis and bone marrow edema in comparison to control group 3 months post intervention. All post-procedural side effects resolved within thmonth without further medical intervention, and no long-term sequelae were identifiedConclusion:Fluoroscopic guided intra-articular steroid injection of inflamed atlantoaxial joints is considered a beneficial therapeutic option in rheumatoid arthritis patients regarding clinical and radiological assessments.References:[1]Taniguchi D, Tokunaga D, Hase H, et al. Evaluation of lateral instability of AAJ in RA using dynamic open-mouth view radiographs. Clin Rheumatol.2008 Jul. 27(7):851-7.Disclosure of Interests:None declared

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