SAT0101 Atlantoepistrophic magnetic resonance imaging involvement in early rheumatoid arthritis
Authors: M. Carotti, F. Salaffi, M. Di Carlo, F. Sessa, A. Giovagnoni
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The involvement of the cervical spine in rheumatoid arthritis (RA) can be essential regarding prognosis and mortality. The early detection of a cervical spine involvement in RA is essential to avoid possibly fatal complications. <h3>Objectives</h3> To assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis (ERA) to evaluate the role of magnetic resonance imaging (MRI) in depicting this early joint involvement and to establish a risk-profile for the individual patient. <h3>Methods</h3> Fifty patients (13 men and 37 women). mean age of 58.2 years (range 36–79 years) with clinical and laboratory evidence of ERA (mean disease duration &lt;12 months) were included in our study. MRI of the atlantoaxial joint was performed in all patients. The MRI features were correlated with clinical, radiological and biochemical variables. All patients underwent radiographic examination of the hands, wrists and feet. The assessment of the structural damage was carried out by two experienced readers, according to simple erosion narrowing scores (SENS). <h3>Results</h3> Twelve (24%) of the 50 patients with early ERA had positive MR findings. In all cases the MR showed pannus surrounded the dents, with additional erosions in 8 patients, bone marrow oedema at atlantoaxial in 9 patients and an abnormal cervico-medullary angle (&lt;135°), in 2 patients. Compared with patients without cervical involvement, these 12 patients showed significantly higher anti-CCP antibodies (ACPA) title [mean 200.25 UI (SD 262.44) vs. mean 22.05 (SD 40.21) (p&lt;0.001); higher swollen joint count (SJC) [mean 13.66 (SD 3.39) vs mean 8.65 (SD 3.38) (p&lt;0.001); higher Ritchie Articular Index (RAI) [mean 33.25 (SD 5.94) vs. mean 20.86 (SD 4.22) (p=0.047); higher GH [mean 69.58 (SD 13.49) vs. mean 45.92 (SD 9.55) (p&lt;0.001); higher Disease Activity Score (DAS) in 44 joints level [mean 5.72 (SD 0.44) vs. mean 4.52 (SD 0.53) (p&lt;0.001); higher Health Assessment Questionnaire Disability Index (HAQ-DI) [mean 1.55 (SD 0.37) vs. mean 1.09 (SD 0.33) (p&lt;0.001), and higher simple erosion narrowing (SENS) scores [mean 15.83 (SD 4.52) vs mean 7.71 (SD 3.43) (p&lt;0.001). Multivariate analysis showed meaningful relationship between ACPAs, high level of DAS and the presence of hand and wrist erosive lesions (SENS) with cervical involvement. <h3>Conclusions</h3> Our results showed that ERA patients with higher disease activity and advanced peripheral erosiveness are indicators of higher risk of early involvement of the atlantoaxial inflammatory synovitis. In daily clinical practice the MRI of cervical spine it should be proposed in patients with prognostic factors of unfavourable disease evolution, even if asymptomatic. <h3>References</h3> [1] Zoli A, Priolo F, Galossi A, Altomonte L, Di Gregorio F, Cerase A, et al. Craniocervical junction involvement in rheumatoid arthritis: a clinical and radiological study. J Rheumatol2000;27:1178–1182. [2] Joaquim AF, Appenzeller S. Cervical spine involvement in rheumatoid arthritis—a systematic review. Autoimmun Rev2014;13:1195–1202. <h3>Disclosure of Interest</h3> None declared