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Arthritis und Rheuma 2010; 30(04): 219-224
DOI: 10.1055/s-0037-1618023
Rheumaorthopädie
Schattauer GmbH

Zervikale Manifestation der rheumatoiden Arthritis

Diagnostik und TherapieCervical manifestation of rheumatoid arthritisDiagnosis and therapy
R. Kothe
1   Abteilung für Wirbelsäulenchirurgie, Interdisziplinäres Wirbelsäulenzentrum, Klinikum Dortmund
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Publication History

Publication Date:
26 December 2017 (online)

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Zusammenfassung

Die zervikale Manifestation der rheumatoiden Arthritis (RA) ist häufig und wird in ihrer Bedeutung für den Rheumakranken immer noch unterschätzt. Die typischen pathophysiologischen Veränderungen reichen von der isolierten atlantoaxialen Subluxation (ASS) bis hin zur komplexen kraniozervikalen und subaxialen Instabilität. Das Auftreten einer zervikalen Myelopathie ist jederzeit möglich und für den Betroffenen mit einer deutlichen Verschlechterung der weiteren Prognose verbunden. Die Therapie der rheumatischen Halswirbelsäule hat neben der Verbesserung der subjektiven Beschwerdesymptomatik vor allem den Stopp des progredienten Krankheitsverlaufes zum Ziel. Letzteres ist nur durch eine operative Behandlung möglich, die im günstigsten Fall auf die Fusion des atlantoaxialen Bewegungssegments beschränkt werden kann. Bei fortgeschrittenen zervikalen Destruktionen sind langstreckige Fusionen vom Okziput bis zur oberen Brustwirbelsäule notwendig. Moderne operative Techniken und Implantatsysteme ermöglichen diese komplexen Eingriffe auch bei fortgeschrittenem Krankheitsverlauf und erhöhter Komorbidität des Rheumakranken.

Summary

The involvement of the cervical spine in rheumatoid arthritis (RA) is common and the importance for the patient is still often underestimated. Pathophysiological changes begin with an isolated atlantoaxial subluxation (AAS) and may progress to a complex craniocervical and subaxial instability. The onset of cervical myelopathy can occur at any time and leads to a deterioration of the prognosis for the patient. Treatment of the rheumatoid cervical spine should be based on the improvement of the symptoms and the prevention of further progress of the disease. The latter is only possible by surgical treatment. In case of isolated ASS, posterior atlantoaxial fusion is the treatment of choice. More complex instabilities may require a longer fusion from the occiput to the upper thoracic spine. Modern techniques and implant systems make this complex surgery also possible in severely disabled patients with a high co-morbidity.

Schlüsselwörter

Rheumatoide Arthritis - Halswirbelsäule - zervikale Myelopathie

Keywords

Rheumatoid arthritis - cervical spine - cervical myelopathy
 

  • Literatur

  • 1 Casey AT, Crockard HA, Geddes JF. et al. Vertical translocation: the enigma of the disappearing atlantodens interval in patients with myelopathy and rheumatoid arthritis: Part1. Clinical, radiological, and neuropathological features. J Neurosurg 1997; 87: 856-862.
    CrossrefPubMedGoogle Scholar
  • 2 Delamarter RB, Bohlmann HH. Postmortem osseous and neuropathologic analysis of the rheumatoid cervical spine. Spine 1994; 19: 2267-2274.
    CrossrefPubMedGoogle Scholar
  • 3 Fujiwara K, Yonenobu K, Ochi T. Natural history of upper lesions in rheumatoid arthritis. J Spinal Disord 1997; 10: 275-281.
    PubMedGoogle Scholar
  • 4 Grob D, Würsch R, Grauer W. et al. Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine 1997; 22: 1580-1584.
    CrossrefPubMedGoogle Scholar
  • 5 Grob D. Atlantoaxial immobilization in rheumatoid arthritis: a prophylactic procedure?. Eur Spine J 2000; 9: 404-440.
    CrossrefPubMedGoogle Scholar
  • 6 Kauppi M, Neva MH. Sensitivity of lateral view cervical spine radiographs taken in the neutral position in atlantoaxial subluxations in rheumatic diseases. Clin Rheumatol 1998; 17: 511-514.
    CrossrefPubMedGoogle Scholar
  • 7 Matteson EL. Cervical spine disease in rheumatoid arthritis: How common a finding? How uncommon a problem?. Arthritis Rheum 2003; 48: 1775-1778.
    CrossrefPubMedGoogle Scholar
  • 8 Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine 2001; 26: 161-165.
    CrossrefPubMedGoogle Scholar
  • 9 Miyata M, Neo M, Ito H. et al. Is rheumatoid arthritis a risk factor for a high-riding vertebral artery?. Spine 2008; 33: 2007-2011.
    CrossrefPubMedGoogle Scholar
  • 10 Neva MH, Kauppi M, Kautiainen H. Combination drug therapy retards the development of rheumatoid atlantoaxial subluxations. Arthritis Rheum 2000; 43: 2397-2401.
    CrossrefPubMedGoogle Scholar
  • 11 Neva MH, Isomaki P, Hannonen P. et al. Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis. Arthritis Rheum 2003; 48: 1808-1813.
    CrossrefPubMedGoogle Scholar
  • 12 Mori K, Imai S, Omura K. et al. Clinical output of the rheumatoid cervical spine in patients with mutilating-type joint involvement. Spine 2010; 35: 1279-1284.
    CrossrefPubMedGoogle Scholar
  • 13 Oda T, Fujiwara K, Yonenobu K. et al. Natural course of cervical spine lesions in rheumatoid arthritis. Spine 1995; 20: 1128-1135.
    CrossrefPubMedGoogle Scholar
  • 14 Oda T, Yonenobu K, Fujimura Y. et al. Diagnostic validity of space available for the spinal cord at C1 level for cervical myelopathy in patients with rheumatois arthritis. Spine 2009; 34: 1395-1398.
    CrossrefPubMedGoogle Scholar
  • 15 Paus AC, Steen H, Roislien J. et al. High mortlity rate in rheumatoid arthritis with subluxation of the cervical spine. Spine 2008; 33: 2278-2283.
    CrossrefPubMedGoogle Scholar
  • 16 Sunahara N, Matsunaga S, Mori T. et al. Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine 1997; 22: 2603-2608.
    CrossrefPubMedGoogle Scholar
  • 17 Shoda N, Seichi A, Takeshita K. et al. Sleep apnea in rheumatoid arthritis patients with occipitocervical lesions: the prevalence and associated radiographic features. Eur Spine J 2009; 18: 905-910.
    CrossrefPubMedGoogle Scholar
  • 18 Weidner A, Wähler M, Chiu ST, Ullrich CG. Modification of C1-C2 transarticular screw fixation by image guided surgery. Spine 2000; 25: 2668-2674.
    CrossrefPubMedGoogle Scholar
  • 19 Wright NM, Lauryssen C. Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg 1998; 88: 634-640.
    CrossrefPubMedGoogle Scholar