Cervical spine involvement in rheumatoid arthritis and ankylosing spondylitis and its relationship with the involvement of upper extremity

Aim: In this study, we aimed to investigate the cervical involvement of rheumatoid arthritis and ankylosing spondylitis and its relationship between involvement of the upper extremity with clinical, radiological and functional assessments.Materials and Methods: 50 adult AS patients diagnosed according to the Modified New York criteria, 50 adult RA patients diagnosed according to 1987 ACR criteria were included in the study. Patients with another inflammatory rheumatic disease except RA and AS, with the malignancy, pregnancy, neurological deficit, who have more than one rheumatic diseases, patients who do not want to participate in the study were excluded. Demographic and clinical evaluations were recorded. In the cervical and upper extremity examination, pain and movement limitations were examined. Cervical spine MRI images were taken in RA patients with contrast injection and AS patients underwent MRI without contrast injection. MRI imaging could not performed in two of the RA patients and one of the AS patients because of their claustrophobia and in 3 AS patients because of giving position was impossible. MR images were performed in T1 and T2 sequences in sagittal, coronal and axial plains. Hiperflexion and extension cervical radiographs of patients in lateral position, hand-wrist, elbow and shoulder radiographs in anteroposterior position were taken. In patients with RA hand-wrist radiographs were scored according to the Sharp-Genant scoring system. In shoulder and elbow radiographs erosions and narrowing were assessed. In cervical spine MRI and hiperflexion-extension radiographs, atlanto-axial subluxation, erosion, narrowing and in addition MRI contrast enhancement were evaluated. The cervical radiographs of patients with AS were scored according to the Berlin x-ray scoring system, MRI were scored according to the ASspiMRI-c scoring system. In elbow, shoulder and hand-wrist radiographs, erosions and narrowing were assessed. In both of the diseases, disability of the upper extremity was assessed with QuickDASH questionnaire, hand disability with DHI and neck disability was assessed with the BDI, quality of life was assessed in RA with RAQoL and in AS with ASQoL, disease activity was assessed with DAS28 in RA, with BASDAI in AS. BASFI was used for functional assessment in AS. The assessment of dexterity was with Purdue Pegboard, hand grip strength was with hand dynamometer (Jamar) and pinch grip strength was with the Pinchmetre.SPSS 16.0 statistical program was used for data analysis. According to the normality test, parametric tests for normally distributed data, independent samples t test and nonparametric tests for data not normally distributed, Mann-Whitney U test were used. Data were compared by Pearson's correlation, univariate and multivariate linear regression analysis. Data were considered as statistically significant at p<0.05.Results: In patients with rheumatoid arthritis, cervical imaging did not show a significant correlation with upper extremity clinically, radiologically and functionally. Cervical movements showed a significant correlation with Pinchmetre (p<0.05), DHI (p<0.05) and QuickDASH (p<0, 01). Neck pain showed a significant correlation with Purdue Pegboard right hand and assembly test (p<0.05), Jamar right hand (p<0.05), QuickDASH (p<0.01) and Pinchmetre left hand lateral and tip pinch, right hand chuck pinch (p<0.05), all of the DHI scores (p <0.01). NDI showed a significant correlation with Purdue Pegboard, right hand, both hands and assembly tests (p <0.05), Jamar of both hands (p<0.01), all of the Pinchmetre tests (p<0.05), DHI scores (p<0.01) and QuickDASH score (p<0.01). In patients with ankylosing spondylitis, significant correlations was found between cervical imaging and shoulder, wrist radiographs (p<0.01), cervical radiograph and all of the Purdue Pegboard tests (p<0.05), cervical MRI and Purdue Pegboard assembly test (p<0.05). Cervical movements showed a significant correlation with shoulder (p<0.05) and wrist radiographs (p<0.01), all of the Purdue Pegboard tests (p<0.01) and the left lateral flexion showed a significant correlation with Jamar right hand (p<0.05) and QuickDASH score (p<0.05). Neck pain showed a significant correlation with DHI total and factor 1 (p<0.01) and factor 2 scores (p<0.05) and QuickDASH score (p<0.01). NDI showed a significant correlation with Purdue Pegboard left hand (p<0.05) and all of the Jamar (p<0.05) values and Pinchmetre values except the left hand tip pinch (p<0.05), DHI total, factor 1 and factor 2 scores (p<0.01) and QuickDASH scores (p<0.01).Conclusion: In rheumatoid arthritis and ankylosing spondylitis, significant correlations are shown especially between neck pain, limitation of neck movement, cervical disability and the disability of upper extremity and hand functions.Key words: rheumatoid arthritis, ankylosing spondylitis, cervical spine involvement, involvement of the upper extremity, hand