الفهرس 
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Abstract
Introduction: Cervical spine involvement is common and potentially severe in patients with rheumatoid arthritis (RA). The aim of the present study was to determine the precise involvement of cervical spine in RA and to compare patients with atlantoaxial subluxation (AAS) and patients without as regard clinical, neurological and laboratory manifestations. Methods: We studied 44 patients who met American College of Rheumatology criteria for RA and had disease durations of 7.7 ±5.42 years. Each patient underwent a physical examination, laboratory tests, standard radiographs (anteroposterior and lateral) and MRI. Results: The prevalence of rheumatoid cervical spine involvement was 27.3% by plain radiography and 61.4% by MRI. The anterior displacement was the most common form of AAS (52.3% of cases) followed by the vertical (13.6%) then the posterior (4.5%). MRI was significantly better than and plain radiography in detecting anterior AAD, odontoid erosion, pannus and cervico-medullary angle <135°. RA patients with AAS were significantly associated with longer disease duration and parameters of disease activity such as higher articular index of Ritchie, DAS28-4V, HAQ, ESR 1st hour, RF positivity and higher CRP value. Conclusion: Cervical spine involvement in the rheumatoid patient is common and progressive. Early diagnosis and treatment is imperative. Because of the high incidence of abnormal morphologic changes shown by MR imaging in patients with normal neurologic findings, regular follow-up should be provided to conservatively treated patients. Inclusion of MRI as a routine in all cases is likely to influence the result because subtle erosions missed by plain radiography could be readily identified by this method. AAS is associated with longer disease duration, disease activity and with rapidly progressive joint destruction.