Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting a significant percentage of the population. Rheumatoid arthritis synovitis affects mostly small hand and feet joints, although it may compromise any joint with a synovial lining. Although cervical involvement occurs usually in longstanding disease in over half of these patients, it is usually preceeded by findings in other joints,such as small joints of the hand. Clinical presentation in spine involvement can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We report the case of a 62 year old female who presented to the medicine outpatient department with a 3 year history of disabling neck pain and episodes of paresthesias along with muscle weakness. On laboratorial workup, positive rheumatoid factor(qualitative and quantitative) along and anti-citrullinated peptide antibody were found. Cervical spine xrays and magnetic resonance series revealed subluxation of the atlanto-axial joint, multiple erosions and odontoid process inflammatory pannus. A diagnosis of rheumatoid arthritis with primary and isolated cervical spine involvement as the initial finding was made and the patient was started on methotrexate and methylprednisolone and referred to the Dept. Of Neurosurgery for cervical spine fixation and fusion.

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