The following is a summary of “Assessment of atlantoaxial joint involvement in patients with rheumatoid arthritis, results from an observational “real-life” study,” published in the November 2023 issue of Rheumatology by Muzio et al.

Rheumatoid arthritis (RA) often affects the atlantoaxial joint, prompting an evaluation of its occurrence and related characteristics within a real-life cohort. A retrospective review of medical records from longitudinally followed-up RA patients estimated the prevalence of severe atlantoaxial joint involvement, measuring the incidence proportion and rate per 1000 person-years at risk. Regression analyses were employed to explore potential associated factors. Subsequently, a prospective recruitment strategy was adopted to conduct a descriptive cross-sectional study that evaluated subclinical atlantoaxial joint involvement in patients sharing similar clinical traits.

The retrospective analysis encompassed 717 patients (56.6% female; mean age 64.7 ± 12.3 years). Severe atlantoaxial joint involvement was observed in 2.1% [1.5–2.5] of cases, identified through MRI and CT scans among 15 out of 717 patients. Across 3091 person-years, the estimated incidence rate stood at 5.2 × 1000 [2.9–8.3] person-years. Regression analyses indicated significant associations between severe atlantoaxial joint involvement and male gender, prolonged disease duration, anti-citrullinated protein antibody (ACPA) positivity, and extra-articular manifestations.

Based on these findings, 30 asymptomatic patients who underwent cervical spine MRI evaluations were selected according to similar clinical criteria. Of these patients, nearly 50% exhibited subclinical atlantoaxial joint involvement. The study’s outcomes shed light on severe atlantoaxial joint participation in a real-life context among RA patients. Factors such as male gender, ACPA positivity, extended disease duration, and extra-articular manifestations appeared to be linked to severe atlantoaxial joint involvement in RA. Furthermore, MRI emerged as a valuable clinical tool for early detection of atlantoaxial joint involvement, even in asymptomatic RA patients.

Source: nature.com/articles/s41598-023-46069-0