Prevalence of Atlanto-axial Subluxation in Patients with Rheumatoid Arthritis
Tipsing W, MD1, Dechanuwong P, MD1, Manavanchai S, MD1
Affiliation : 1 Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
Objective : To determine the prevalence and associated factors of atlanto-axial subluxation in patients with rheumatoid arthritis
(RA).
Materials and Methods : A cross-sectional study using database of patients with RA who visited rheumatologic clinic in the authors’
institution between September 2014 and February 2015 was performed. Data collected were demographic, laboratory and imaging
data.
Results : During the study period, 231 patients were included. The mean age was 55.2+11.8 years. Majority of patients (92.6%) were
female. Atlanto-axial subluxation was found in 40 patients (17.3%): 35 (15.1%) had anterior type only, two (0.9%) had vertical type,
and three (1.3%) had combined anterior and vertical subluxation. Factors which were significantly associated with atlanto-axial
subluxation were simple disease activity index score (p = 0.024), health assessment questionnaire score (p<0.001) and modified
total sharp score (p = 0.002). There was no association among atlanto-axial subluxation and age, sex, anti–cyclic citrullinated
peptide antibody, rheumatoid factor, duration of disease, extra-arthricular manifestation, drug use, disease activity score 28, clinical
disease activity index, C-reactive protein, IL-6 and procalcitonin.
Conclusion : Atlanto-axial subluxation is highly prevalent in RA patients. Factors associated with atlanto-axial subluxation represent
high disease activity, high degree of functional disability and radiological severity of RA.
Keywords : Atlanto-axial subluxation, Disease activity, Functional disability, Radiological severity, Rheumatoid arthritis
