Magnetic resonance imaging of the craniovertebral junction in early rheumatoid arthritis

OBJECTIVE: To assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis (ERA) and to elucidate the risk profile for the individual patient. MATERIALS AND METHODS: Consecutive ERA patients (disease duration < 12 months) were included in our study. A cervical spine magnetic resonance imaging (MRI) and X-rays (cervical spine, hands, wrists, and feet) were performed in all patients. The MRI features were correlated with clinical, radiological, and biochemical variables. RESULTS: Fifty patients (13 men and 37 women) with a mean age of 58.2 years (range, 36-79 years) were included in the study. In 12 (24%) patients were detectable MRI findings suggestive of the craniovertebral junction involvement. Compared with patients without cervical involvement, the patients with atlantoaxial synovitis showed a significantly higher anti-citrullinated protein antibodies (ACPA) titer [mean 200.25 UI (SD 262.44) vs. mean 22.05 (SD 40.21) (p < 0.001)]; a worse Disease Activity Score 44 joints (DAS44) [mean 5.72 (SD 0.44) vs. mean 4.52 (SD 0.53) (p < 0.001)]; a worse Health Assessment Questionnaire Disability Index (HAQ-DI) [mean 1.55 (SD 0.37) vs. mean 1.09 (SD 0.33) (p < 0.001)], and a higher Simple Erosion Narrowing Score (SENS) [mean 15.83 (SD 4.52) vs. mean 7.71 (SD 3.43) (p < 0.001)]. The multivariate analysis revealed a meaningful relationship between atlantoaxial synovitis and ACPA, DAS44, and the presence of an erosive disease. CONCLUSIONS: The craniovertebral junction is frequently involved in ERA patients. ACPA, high disease activity, and erosive disease at baseline are predictors of atlantoaxial involvement.