Prevalence and Risk Factors of Anterior Atlantoaxial Subluxation in Ankylosing Spondylitis

2012 ◽  
Vol 39 (12) ◽  
pp. 2321-2326 ◽  
Author(s):  
JI-SEON LEE ◽  
SEUNGHUN LEE ◽  
SO-YOUNG BANG ◽  
KYUNG SOO CHOI ◽  
KYUNG BIN JOO ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Smoking Status ◽  
Disease Process ◽  
Lateral View ◽  
Atlantoaxial Subluxation ◽  
Progression Rate ◽  
Peripheral Arthritis ◽  
Antiinflammatory Drugs

Objective.In ankylosing spondylitis (AS), the cervical spine, like other sections of the spine and sacroiliac joints, is vulnerable during the disease process. Atlantoaxial subluxation (AAS) has been studied in connection with AS, but its risk factors and progression have not been clarified. Therefore, this study assessed the prevalence and risk factors of AAS in patients with AS.Methods.A total of 819 patients with AS who fulfilled the modified New York criteria and were examined with a full-flexion lateral view of the cervical spine by radiograph were enrolled from an outpatient clinic. The medical records of the patients were retrospectively reviewed and the anterior atlantodental interval (AADI) in the lateral flexion view of the cervical spine radiograph was investigated by 2 experienced musculoskeletal radiologists. We defined the AAS as an AADI of > 3 mm, and progression of AADI as a progression rate > 0.5 mm/year.Results.AAS was found in 14.1% (116/819) of patients. Progression of AADI occurred in 32.1% (26/81) patients with AAS and 5.0% (16/320) patients without AAS (p < 0.001). The development of AAS was significantly associated with elevated C-reactive protein [CRP; OR 2.19 (1.36–3.53)], peripheral arthritis [OR 2.05 (1.36–3.07)], use of anti-tumor necrosis factor antagonists because of failure of nonsteroidal antiinflammatory drugs/disease-modifying antirheumatic drugs [NSAID/DMARD; OR 2.28 (1.52–3.42)], and uveitis [OR 1.71 (1.13–2.59)]. These factors were adjusted for age, sex, and disease duration by logistic regression analysis. No clear association was found for HLA-B27, seropositivity, or smoking status with AAS.Conclusion.AAS is a frequent complication, and the progression of AADI was more rapid in cases with AAS. The presence of peripheral arthritis, or high disease activity with elevated CRP level or refractory to conventional NSAID/DMARD, independently increased the risk of AAS, suggesting that clinicians should focus on the detection and monitoring of AAS, especially in cases with associated risk factors.

scholarly journals Double crush syndrome: clinical review of an unsolved puzzle

2020 ◽  
Vol 6 (6) ◽  
pp. 1362
Author(s):  
Deven R. Kuruwa ◽  
Easwar Elango ◽  
Kunal A. Shah
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Peripheral Nerve ◽  
Carpal Tunnel ◽  
Current Knowledge ◽  
Disease Process ◽  
Crush Syndrome ◽  
Definitive Treatment ◽  
Double Crush ◽  
Double Crush Syndrome

<p class="abstract">Double crush syndrome (DCS) involves compression of a peripheral nerve at two different segments. Median nerve is most commonly involved with proximal compression at the level of cervical spine and distal compression in the carpal tunnel. Little consensus exists in literature regarding its epidemiology, risk factors, pathophysiology and definitive treatment. The purpose of this article is to summarize our current knowledge about this disease process as well as to touch upon the controversies that have been generated in recent times.</p>

scholarly journals Atlantoaxial subluxation in an ankylosing spondylitis patient with cervical spine ossification

Rheumatology ◽  
1997 ◽  
Vol 36 (2) ◽  
pp. 293-295 ◽  
Author(s):  
E. Toussirot ◽  
A. Benmansour ◽  
J. F. Bonneville ◽  
D. Wendling
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Atlantoaxial Subluxation

Comparison of the Clinical Expression of Patients with Ankylosing Spondylitis from Europe and Latin America

2012 ◽  
Vol 39 (12) ◽  
pp. 2315-2320 ◽  
Author(s):  
MARIANA BENEGAS ◽  
ELISA MUÑOZ-GOMARIZ ◽  
PILAR FONT ◽  
RUBEN BURGOS-VARGAS ◽  
JOSÉ CHAVES ◽  
...  
Keyword(s):  
Latin America ◽  
Ankylosing Spondylitis ◽  
Latin American ◽  
Disease Duration ◽  
Measurement Data ◽  
Clinical Manifestations ◽  
Hla B27 ◽  
Peripheral Arthritis ◽  
Antiinflammatory Drugs ◽  
Significant Difference

Objective.To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA).Methods.We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out.Results.There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations.Conclusion.The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.

Atlantoaxial Subluxation in Different Intraoperative Head Positions in Patients with Rheumatoid Arthritis

2006 ◽  
Vol 104 (4) ◽  
pp. 675-679 ◽  
Author(s):  
Daisaku Tokunaga ◽  
Hitoshi Hase ◽  
Yasuo Mikami ◽  
Tatsuya Hojo ◽  
Kazuya Ikoma ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
General Anesthesia ◽  
Perioperative Period ◽  
Head Position ◽  
Lateral View ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Upper Cervical ◽  
Atlantodental Interval

Background Disorders of the cervical spine are often observed in patients with rheumatoid arthritis (RA). However, the best head position for RA patients with atlantoaxial subluxation in the perioperative period is unknown. This study investigated head position during general anesthesia for the patients with RA and proven atlantoaxial subluxation. Methods During anesthesia of patients with RA and proven atlantoaxial subluxation, the authors used fluoroscopy to obtain a lateral view of the upper cervical spine in four different positions: the mask position, the intubation position, the flat pillow position, and the protrusion position. Copies of the still fluoroscopic images were used to determine the anterior atlantodental interval, the posterior atlantodental interval, and the angle of atlas and axis (C1-C2 angle). Results The anterior atlantodental interval was significantly smaller in the protrusion position (2.3 mm) than in the flat pillow position (5.1 mm) (P &lt; 0.05). The posterior atlantodental interval was significantly greater in the protrusion position (18.9 mm) than in the flat pillow position (16.2 mm) (P &lt; 0.05). The C1-C2 angle was, on average, 9.3 degrees greater in the protrusion position than in the flat pillow position (P &lt; 0.05). Conclusion This study showed that the protrusion position using a flat pillow and a donut-shaped pillow during general anesthesia reduced the anterior atlantodental interval and increased the posterior atlantodental interval in RA patients with atlantoaxial subluxation. This suggests that the protrusion position, which involves support of the upper cervical spine and extension at the craniocervical junction, might be advantageous for these patients.

Manifestations of Cervical Spine Involvement in Longstanding Ankylosing Spondylitis: Atlantoaxial Ankylosis and Atlantoaxial Subluxation

2017 ◽  
Vol 24 (1) ◽  
pp. 21
Author(s):  
Jeong Hoon Lee ◽  
Seunghun Lee ◽  
Bong Gun Lee ◽  
Soon Young Song ◽  
Tae-Hwan Kim ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Atlantoaxial Subluxation

Medikamentöse Therapie der Spondylitis ankylosans

2013 ◽  
Vol 33 (02) ◽  
pp. 99-105
Author(s):  
W. Hermann ◽  
U. Müller-Ladner ◽  
F. M. P. Meier
Keyword(s):  
Ankylosing Spondylitis ◽  
Prostaglandin Synthesis ◽  
Peripheral Arthritis ◽  
Antiinflammatory Drugs ◽  
Cytokine Tumor Necrosis Factor ◽  
Inflammatory Bowel ◽  
Cox 2 ◽  
Factor Α ◽  
Cox 2 Inhibitors ◽  
Necrosis Factor

SummaryThe group of spondyloarthritides (SpA) consists of ankylosing spondylitis and the subgroups psoriatic arthritis, arthritis related to inflammatory bowel disease, reactive arthritis and undifferentiated peripheral arthritis. The classification criteria of „The Assessments in Ankylosing Spondylitis International Society“ (ASAS) aims to differentiate between axial and peripheral disease. In this work, it was seeked to differentiate pharmacological treatment in this respect. Focus was thereby set on two main treatment principles: reduction of prostaglandin synthesis by blockade of cyclooxygenase-2 (COX-2) either by conventional non-steroidal antiinflammatory drugs (NSAID) or selective COX-2-Inhibitors, as well as by blockade of the proinflammatory cytokine tumor-necrosis-factor-α via so-called biologicals.

Rheumatoid Atlantoaxial Subluxation Can Be Prevented by Intensive Use of Traditional Disease Modifying Antirheumatic Drugs

2009 ◽  
Vol 36 (2) ◽  
pp. 273-278 ◽  
Author(s):  
MARKKU J. KAUPPI ◽  
MARKO H. NEVA ◽  
KARI LAIHO ◽  
HANNU KAUTIAINEN ◽  
REIJO LUUKKAINEN ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Disease Activity ◽  
Health Assessment ◽  
Lateral View ◽  
Atlantoaxial Subluxation ◽  
Dmard Therapy ◽  
Increased Risk ◽  
Full Flexion ◽  
Disease Modifying ◽  
Spine Disorders

Objective.To evaluate the 5-year incidence of cervical spine disorders in patients with early rheumatoid arthritis (RA) treated by 2 different disease modifying antirheumatic drug (DMARD) strategies.Methods.In a national, multicenter, prospective FIN-RACo-trial, a cohort of 199 patients with early, clinically active RA was randomly assigned to treatment with a combination of 3 DMARD and prednisolone (Combi group) or with a single DMARD (Single group) with or without prednisolone, aiming to induce remission. After 2 years, the DMARD therapy was unrestricted. Lateral view cervical spine radiographs during full flexion and extension were taken at the 5-year followup visits. The presence of anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI), and subaxial subluxation (SAS) was assessed in the 149 patients with radiographs available (80 Single and 69 Combi).Results.At the 5-year visits, aAAS, AAI, and SAS were found in 13 (9%), 6 (4%), and 9 (6%) patients, respectively. The corresponding Single/Combi group ratios were 11/2, 5/1, and 5/4. Of the baseline data, only poor physical function [Health Assessment Questionnaire (HAQ); p = 0.024] and Single treatment strategy (p = 0.019) were significantly associated with aAAS. Worse HAQ scores and Disease Activity Score 28 values were found in patients who developed aAAS during the 5-year followup.Conclusion.RA patients with sustained clinical disease activity and poor HAQ are at increased risk of developing aAAS. The development of aAAS during the first 5 years of RA was rare among the patients treated with a combination of DMARD for at least 2 years from the diagnosis. Intensive treatment with traditional DMARD prevents or retards the development of aAAS in patients with recentonset RA.

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