A.R. GARAEVA¹, S.A. LAPSHINA¹, V.I. ANISIMOV², R.Z. ABDRAKIPOV², E.V. SUKHORUKOVA², Z.N. GABDULLIA², 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. — postgraduate student 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 identify the relationship of clinical characteristics with MRI-verified atlantoaxial changes in patients with rheumatoid arthritis.

Material and methods. 30 patients with rheumatoid arthritis were examined, mean age was 53.3 ± 13.51 years. Mean activity score (DAS28 (CRP)) was 5.24 ± 0.62. Median disease duration was 137 [12; 660] months. Extended clinical examination included: assessment of neurological status, presence of neuropathic pain components and central sensitization, assessment of quality of life, and degree of functional impairment. MRI of the craniovertebral junction with measurement of 5 craniometric parameters was performed for the dens axis translocation.

Results. 60% of patients had complaints of pain in the craniovertebral junction: in the neck — 76.7%, in the occipital region — 33.3%, with a mean VAS 6.34 ± 1.84 mm. The mean HAQ value was 1.64 ± 0.61, EQ-5D 0.45 ± 0.51; SF-36 mental component was 38.23 ± 9.35; physical component was 31.44 ± 8.98. Neurological disorders were detected in 53.3% at objective examination: motor disorders in 26.7%, changes in superficial sensitivity in 30%, parasthesias in 40%. Various MRI changes were noted in 96.7% of patients. We found correlations of atlantoaxial changes with ESR (rSp=0.470; p=0.018), CRP (rSp = -0.935; p = 0.006), number of painful joints (rSp = 0.503; p = 0.009), patients’ age (rSp = 0.461; p = 0.018), body mass index (rSp = -0.447; p = 0.022), number of comorbidities (rCp = -0.541; p = 0.005), quality of life according to EQ-5D (rCp = -0.400; p = 0.043), presence of central sensitization according to CSI questionnaire (rCp = -0.601; p = 0.001), and with psychological component of SF-36 questionnaire (rCp = -0.492; p = 0.011).

Conclusion. Patients with RA have various MRI changes of the craniovertebral junction, both in the form of asymptomatic initial manifestations of translocation and with signs of neurological deficit due to spinal cord compression. Changes in the atlantoaxial region according to MRI correlated with the level of inflammatory markers, peripheral arthritis, comorbid pathology, patient’s age, and quality of life.

Key words: atlantoaxial articulation, atlas, magnetic resonance imaging, rheumatoid arthritis.

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