The retrospective study of craniocervical junction involvement in inflammatory arthritis by using computer tomography and magnetic resonance imaging

The aim of this study to examine the craniocervical involvement of patients with inflammatory arthritis. A total of 459 patients; 204 of these patients were RA, 200 were AS and 55 were PsA patients, who underwent CT and /or MRI of the cervical vertebra for any reason in the Hacettepe University Department of Internal Medicine, Division of Rheumatology between 2010-2020, were included in the study. Craniocervical junction involvement was detected in 164/459 (35.7%) patients. 101/204 (49.5%) of these patients were RA, 53/200 (26.5%) were AS, 10/55 (18.2%) were PsA patients. Any type of the involvement and odontoid process pathologies were more common in RA patients than in the AS and PsA groups (p <0.001). There were odontoid process pathologies in 69 (33.8%), VS in 24 (11.8%), atlanto-axial joint pathologies in 23 (12.4%), AAS in 17 (8.3%), SAS in 12 (5.9%), atlanto-occipital joint pathologies in 6 (3.2%) RA patients. In multivariate analysis performed to investigate the factors associated with craniocervical involvement in rheumatoid arthritis patients, age of diagnosis, duration of disease, and C-reactive protein were found to be independently related. 8/101 (7.9%) patients with craniocervical junction involvement had spinal cord compression. Odontoid process pathologies were detected in 24 (12%) and VS was detected in 20 out of (10.0%) 200 patients. Most of the patients with the involvement were male (p = 0.029). Only one (1.9%) out of 53 patients with craniocervical junction involvement had spinal cord compression. There were 6 PsA patients with VS, 2 patients with AAS, 2 patients with odontoid process pathologies. Craniocervical junction involvement occurs in large group of inflammatory artritis patients, especially with RA. This area, which has the potential to be overlooked clinically, needs to be evaluated more carefully.