A.R. GARAEVA¹, S.A. LAPSHINA¹, V.I. ANISIMOV², R.Z. ABDRAKIPOV², E.V. SUKHORUKOVA², Z.N. GABDULLINA², E.S. ZAMANOVA², D.I. ABDULGANIEVA^1,2, E.I. BOGDANOV^1, 2

 ¹Kazan State Medical University, Kazan

²Republic Clinical Hospital, Kazan

 Contact details:

Garaeva A.R. — resident doctor of the Department of Hospital Therapy

Address: 49 Butlerov St., Kazan, Russian Federation, 420012, tel.: +7-917-865-70-95, e-mail: alina-garaeva97@mail.ru

 The purpose — to assess the early imaging changes in the atlantoaxial area and to compare them with clinical and laboratory characteristics in patients with ankylosing spondylitis (AS).

Material and methods. 20 patients with AS were examined, the average age is 44.2 ± 12.66 y. o. Activity (ASDAS(CRP)): very high — 85%, high — 5%, low — 10%. X-ray stage of sacroiliitis: 2 — 60%, 3 — 15%, 4 — 25%. Functional deficiency (FD): 3 — 55%, 2 — 20%, 1 — 25%. The duration of illness was 176 [2; 360] months. The extended clinical examination included: assessment of neurological status, presence of components of neuropathic pain (NP) and central sensitization (CS), assessment of quality of life, degree of functional disorders. Magnetic resonance imaging (MRI) of the craniovertebral junction was performed with the measurement of 5 craniometric parameters (CMP) for the presence of translocation of the dens axis.

Results. Neck pain syndrome — 75%: inflammatory — 95%, non-inflammatory — 80% (NP — 65%, CS — 50%). VAS: 5.75 ± 2.09. FD: BASMI — 3.86 [2; 7], BASFI — 4,84 [0,7; 8,7]. 75% — limitation of neck rotation, 65% — increase in the distance of the trestle-wall. CMP: 100% — decrease in the retroflex angle, 20% — increase in the anterior atlantodental index, 15% — translocation relative to the Chamberlain line, 10% increase in pB-C2, 5% — decrease in the posterior atlantodental index. A correlation was revealed between the CMP with the X-ray stage (rSp = 0.629; p = 0.021), BASMI (rSp = 0.575; p = 0.04) and the psychological component SF-36 (rSp = 0.570; p = 0.042). The angle of retroflexion with the duration of the disease (rSp = -0.580; p = 0.038), CRP (rSp = 0.624; p = 0.023).

Conclusions. All patients with AS had pathological MRI changes in the form of initial manifestations of translocation of the dens, which had nonspecific clinical manifestations. Changes in craniovertebral transition to MRI did not correlate with disease activity (ASDAS (CRP)), but were associated with the level of CRP, duration of the disease, X-ray stage of sacroiliitis and functional indices (BASMI).

Key words: Atlantoaxial articulation, atlas, magnetic resonance imaging, ankylosing spondylitis.

REFERENCES

1. Salaffi F., Carotti M., Di Carlo M. et al. Craniocervical junction involvement in musculoskeletal diseases: an area of close collaboration between rheumatologists and radiologists. Radiol Med, 2020, vol. 125 (7), pp. 654–667.
2. Poddubnyy D., Vahldiek J., Spiller I. Evaluation of 2 screening strategies for early identification of patients with axial spondyloarthritis in primary care. J Rheumatol, 2011, vol. 38, pp. 2452–2460.
3. Iizuka H., Nishinome M., Sorimachi Y. et al. The characteristics of bony ankylosis of the facet joint of the upper cervical spine in rheumatoid arthritis patients. Eur. Spine J, 2009, vol. 18 (8), pp. 1130–1134.
4. De Wandele I., Calders P., Peersman W. et al. Autonomic symptom burden in the hypermobility type of Ehlers-Danlos syndrome: a comparative study with two other EDS types, fibromyalgia, and healthy controls. Semin Arthritis Rheum, 2014, vol. 44, pp. 353–361.
5. Koby M. The discordant report — pathological radiological findings: a peripatetic review of salient features of neuropathology in the setting of an erstwhile standard «normal» radiological assessment. In: Batzdorf U, ed. 2014 CSF Colloquium Proceedings: Co-Morbidities that Complicate the Treatment and Outcomes of Chiari Malformation, 2015, pp. 50–51.
6. Henderson F.C., Sr. Rosenbaum R., Narayanan M. et al. Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization. Neurosurg Rev, 2021, vol. 44 (3), pp. 1553–1568.
7. Erdes Sh.F., Bochkova A.G., Dubinina et al. Working classification and early diagnosis of ankylosing spondylitis. Klinicheskaya meditsina, 2014, no. 92 (6), pp. 5–11 (in Russ.).
8. Rifbjerg-Madsen S., Christensen A.W., Christensen R. et al. Pain and pain mechanisms in patients with inflammatory arthritis: A Danish nationwide crosssectional DANBIO registry survey. PLoS One, 2017, vol. 12 (7).
9. Mayer T., Neblett R., Cohen H. et al. The Development and Psychometric Validation of the Central Sensitization Inventory. Pain Practice, 2011, vol. 12 (4), pp. 276–285.
10. Ware J.E., Snow K.K., Kosinski M. et al. SF-36 Health Survey: Manual and Interpretation Guide, 1993.
11. Ramiro S., Nikiphorou E., Sepriano A. et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Annals of the Rheumatic Diseases, 2023, vol. 82, pp. 19–34.
12. Martin J.E., Bookland M., Moote D. et al. Standardized method for the measurement of Grabb’s line and clival-canal angle. Journal of neurosurgery. Pediatrics, 2017, vol. 20 (4), pp. 352–356.
13. Khaleel Z.L., Besachio D.A., Bisson E.F. et al. Estimation of odontoid process posterior inclination, odontoid height, and pB-C2 line in the adult population. J Neurosurg Spine, 2014, vol. 20, pp. 172–177.
14. Slobodin G., Shpigelman A., Dawood H. et al. Craniocervical junction involvement in ankylosing spondylitis. Eur Spine J, 2015, vol. (12), pp. 2986–2990.
15. Joaquim A.F., Evangelista Santos Barcelos A.C., Daniel J.W. et al. Chamberlain’s Line Violation in Basilar Invagination Patients Compared with Normal Subjects: A Systematic Literature Review and Meta-Analysis. World Neurosurg, 2023, S1878-8750(23)00205-X.
16. Zikou A.K., Alamanos Y., Argyropoulou M.I. et al. Radiological cervical spine involvement in patients with rheumatoid arthritis: a cross sectional study. J Rheumatol, 2005, vol. 32 (5), pp. 801–806.
17. Joaquim A.F., Appenzeller S. Cervical spine involvement in rheumatoid arthritis — a systematic review. Autoimmun Rev, 2014, vol. 13, pp. 1195–1202.
18. Hamdi W., Alaya Z., Ghannouchi M.M. et al. Associated risk factors with worse functional prognosis and hip replacement surgery in ankylosing spondylitis. Joint Bone Spine, 2012, vol. 79 (1), pp. 94–96.
19. Vetti N., Krakenes J., Ask T. et al. Follow-up MR imaging of the alar and transverse ligaments after whiplash injury: a prospective controlled study. AJNR Am J Neuroradiol, 2011, vol. 32 (10), pp. 1836–1841.
20. Karaaslan B., Borcek A.O., Ucar M. et al. Can the Etiopathogenesis of Chiari Malformation Be Craniocervical Junction Stabilization Difference? Morphometric Analysis of Craniocervical Junction Ligaments. World Neurosurg, 2019, vol. 128, pp. 1096–1101.
21. Botelho R.V., Melo Diniz J.J. Basilar Invagination: cranio-cervical kyphosis rather than prolapse from the upper cervical spine. Neurol Neuromedicine, 2017, vol. 2 (3), pp. 15–19.
22. Korb C., Awisat A., Rimar D. et al. Ankylosing Spondylitis and Neck Pain: MRI Evidence for Joint and Entheses Inflammation at the Craniocervial Junction. Isr Med Assoc J, 2017, vol. 19 (11), pp. 682–684.