类风湿关节炎寰枢椎受累的临床特点及磁共振成像的重要性
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摘要
目的分析类风湿关节炎(rheumatoid arthritis, RA)并发寰枢椎关节受累的临床特点,评估磁共振成像(magnetic resonance imaging,MRI)在诊断寰枢椎受累中的临床价值。方法纳入40例RA患者,所有患者均行颈椎X线片和寰枢椎MRI检查,根据有无寰枢椎受累分为2组。收集RA患者的实验室数据和临床资料,比较RA寰枢椎受累组和无寰枢椎受累组上述数据的差异,分析X线和MRI对于寰枢椎受累诊断的优缺点。结果 40例RA患者中,女性28例,男性12例,寰枢椎受累组16例,无寰枢椎受累组24例。16例寰枢椎受累组患者中4例为早期RA患者;MRI检查发现寰枢椎半脱位(atlantoaxial subluxation,AAS)7例(43.75%),血管翳10例(62.50%);颈椎X线检查,仅6例提示寰枢椎有病变,均为AAS。寰枢椎受累组RA患者的体质量指数(body mass index,BMI)平均水平明显低于无寰枢椎受累组[(20.89±3.01)kg/m~2vs.(24.31±3.29)kg/m~2,P=0.011]。与无寰枢椎受累组比较,RA寰枢椎受累组的病程[(167.69±171.73)月vs.(130.75±171.05)月]、红细胞沉降率(erythrocyte sedimentation rate,ESR)[(59.40±35.95)mm/h vs.(51.88±30.25)mm/h]、C反应蛋白(C reactive protein,CRP)[(38.97±42.34)mg/L vs.(32.97±37.26)mg/L]、疾病活动性评分(disease activity score,DAS28)[(5.96±1.86)vs.(5.55±1.70)]的平均水平均高,但差异无统计学意义(P>0.05)。寰枢椎受累组RA患者骨侵蚀情况明显高于无寰枢椎受累组,且差异有统计学意义(χ~2=6.077,P<0.05)。结论 RA早期即可出现寰枢椎病变,外周关节破坏严重的RA患者更容易出现寰枢椎受累,MRI在RA寰枢椎受累的早期诊断中发挥着重要的临床作用。
Objective To explore the clinical features of atlanto-axial joint involvement in patients with rheumatoid arthritis(RA),and evaluate the clinical value of magnetic resonance imaging(MRI) in the diagnosis of atlanto-axial joint involvement. Methods Forty patients with RA who had underwent cervical X-ray and atlanto-axial MRI were enrolled in this study, and they were divided into two groups according to with or without atlanto-axial involvement. Laboratory data and clinical data were recorded and compared between the two groups. Advantages and disadvantages were compared between X-ray and MRI in diagnosis of atlantoaxial involvement. Results Among the 40 RA patients,28 were female.There were 16 patients who had atlantoaxial joint involvement,including 4 early RA patients. The other 24 patients were without atlantoaxial joint involvement.MRI showed atlantoaxial subluxation(AAS) in 7 patients(43.75%), and pannus in 10(62.50%). Cervical X-ray results discovered only 6 patients with AAS. The average body mass index(BMI)of patients with atlantoaxial joint involvement was significantly lower than that without atlantoaxial joint involvement [(20.89±3.01)kg/m~2 vs.(24.31±3.29)kg/m~2, P=0.011). Compared patients without atlantoaxial joint involvement,the mean value of the disease course [(167.69±171.73) months vs.(130.75±171.05)months],erythrocyte sedimentation rate(ESR)[(59.40±35.95)mm/h vs.(51.88±30.25)mm/h],C reactive protein(CRP)[(38.97±42.34)mg/L vs.(32.97±37.26)mg/L]and disease activity score(DAS28)[(5.96±1.86) vs.(5.55±1.70)] were higher in patients with atlantoaxial joint involvement, but the difference was not statistically significant(P>0.05). The rate of bone erosion in RA patients with atlantoaxial joint involvement was significantly higher than that in patients without atlantoaxial joint involvement(χ~2=6.077,P<0.05). Conclusions Atlanto-axial joint involvement may occur in early RA, and patients with peripheral joint erosion are more likely to have atlanto-axial joint involvement. MRI plays an important role in early diagnosis of atlanto-axial joint involvement in RA.
Objective To explore the clinical features of atlanto-axial joint involvement in patients with rheumatoid arthritis(RA),and evaluate the clinical value of magnetic resonance imaging(MRI) in the diagnosis of atlanto-axial joint involvement. Methods Forty patients with RA who had underwent cervical X-ray and atlanto-axial MRI were enrolled in this study, and they were divided into two groups according to with or without atlanto-axial involvement. Laboratory data and clinical data were recorded and compared between the two groups. Advantages and disadvantages were compared between X-ray and MRI in diagnosis of atlantoaxial involvement. Results Among the 40 RA patients,28 were female.There were 16 patients who had atlantoaxial joint involvement,including 4 early RA patients. The other 24 patients were without atlantoaxial joint involvement.MRI showed atlantoaxial subluxation(AAS) in 7 patients(43.75%), and pannus in 10(62.50%). Cervical X-ray results discovered only 6 patients with AAS. The average body mass index(BMI)of patients with atlantoaxial joint involvement was significantly lower than that without atlantoaxial joint involvement [(20.89±3.01)kg/m~2 vs.(24.31±3.29)kg/m~2, P=0.011). Compared patients without atlantoaxial joint involvement,the mean value of the disease course [(167.69±171.73) months vs.(130.75±171.05)months],erythrocyte sedimentation rate(ESR)[(59.40±35.95)mm/h vs.(51.88±30.25)mm/h],C reactive protein(CRP)[(38.97±42.34)mg/L vs.(32.97±37.26)mg/L]and disease activity score(DAS28)[(5.96±1.86) vs.(5.55±1.70)] were higher in patients with atlantoaxial joint involvement, but the difference was not statistically significant(P>0.05). The rate of bone erosion in RA patients with atlantoaxial joint involvement was significantly higher than that in patients without atlantoaxial joint involvement(χ~2=6.077,P<0.05). Conclusions Atlanto-axial joint involvement may occur in early RA, and patients with peripheral joint erosion are more likely to have atlanto-axial joint involvement. MRI plays an important role in early diagnosis of atlanto-axial joint involvement in RA.
引文
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[2] Krauss WE,Bledsoe JM,Clarke MJ,et al.Rheumatoid arthritis of the craniovertebral junction[J].Neurosurgery,2010,66:83-95.
[3] Neva MH,H?kkinen A,M?kinen H,et al.High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery[J].Ann Rheum Dis,2006,65:884-888.
[4] Wasserman BR,Moskovich R,Razi AE.Rheumatoid arthritis of the cervical spine-clinical considerations[J].Bull NYU Hosp Jt Dis,2011,69:136-148.
[5] Yurube T,Sumi M,Nishida K,et al.Incidence and aggravation of cervical spine instabilities in rheumatoid arthritis:a prospective minimum 5-year follow-up study of patients initially without cervical involvement[J].Spine(Phila Pa 1976),2012,37:2136-2144.
[6] Fombon FN,Thompson JP.Anesthesia for the adult patients with rheumatoid arthritis[J].Contin Educ Anesth Crit Care Pain,2006,6:235-239.
[7] Kauppi MJ,Neva MH,Laiho K,et al.Rheumatoid atlantoaxial subluxation can be prevented by intensive use of traditional disease modifying antirheumatic drugs[J].J Rheumatol,2009,36:273-278.
[8] Joaquim AF,Ghizoni E,Tedeschi H,et al.Radiological evaluation of cervical spine involvement in rheumatoid arthritis[J].Neurosurg Focus,2015,38:E4
[9] Liu YY,Long L,Wang SY,et al.Circulating Dickkopf-1 and osteoprotegerin in patients with early and longstanding rheumatoid arthritis[J].Chin Med J (Engl),2010,123:1407-1412.
[10] Renna R,Plantone F,Plantone D.Atlantoaxial subluxation in rheumatoid arthritis[J].J Rheumatol,2013,40:1925.
[11] Mohamed Y.Contribution of dynamic radiographs in atlantoaxial subluxation in rheumatoid arthritis[J].La Tunisie médicale,2014,92:467-473.
[12] Nazarinia M,Jalli R,Kamali Sarvestani E,et al.Asympto-matic Atlantoaxial Subluxation in Rheumatoid Arthritis[J].Acta Medica Iranica,2014,52:462-466.
[13] Blom M,Creemers MC,Kievit W,et al.Long-term follow-up of the cervical spine with conventional radiographs in patients with rheumatoid arthritis[J].Scand J Rheumatol,2013,42:281-288.
[14] Ahn JK,Hwang JW,Oh JM,et al.Risk factors for development and progression of atlantoaxial subluxation in Korean patients with rheumatoid arthritis[J].Rheumatology International,2011,31:1363-1368.
[15] Yurube T,Sumi M,Nishida K,et al.Accelerated develop-ment of cervical spine instabilities in rheumatoid arthritis:a prospective minimum 5-year cohort study[J].PLoS One,2014,9:e88970.
[16] Han MH,Ryu JI,Kim CH,et al.Factors that predict risk of cervical instability in rheumatoid arthritis patients[J].Spine(Phila Pa 1976),2017,42:966-973.
[17] Magarelli N,Simone F,Amelia R,et al.MR imaging of atlantoaxial joint in early rheumatoid arthritis[J].Radiol Med,2010,115:1111-1120.
[18] Younes M,Belghali S,Kriaa S,et al.Compared imaging of the rheumatoid cervical spine:prevalence study and associated factors[J].Joint Bone Spine,2009,76:361-368.
[19] Kaito T,Ohshima S,Fujiwara H,et al.Predictors for the progression of cervical lesion in rheumatoid arthritis under the treatment of biological agents[J].Spine(Phila Pa 1976),2013,38:2258-2263.
[20] Kaito T,Hosono N,Ohshima S,et al.Effect of biological agents on cervical spine lesions in rheumatoid arthritis[J].Spine(Phila Pa 1976),2012,37:1742-1746.