Atlanto-axial Pannus in Patients with and without Rheumatoid Arthritis

Objective Pannus formation in the atlanto-axial joint is a well-recognized complication of rheumatoid arthritis (RA). Occasionally, atlanto-axial pannus is reported when patients without a history of RA undergo magnetic resonance imaging (MRI) of the cervical spine. We sought to further characterize these patients. Methods The Partners HealthCare Research Patient Data Registry was free-text searched for ‘atlanto-axial’ AND ‘pannus’ in cervical spine MRI reports from 2001 to 2015. Cases with MRI reports describing pannus were reviewed. Clinical data were extracted by chart review in cases with confirmed atlanto-axial pannus (n=105). Results Twenty-nine patients (27.6%) had RA, all of whom except one carried this diagnosis at the time of the MRI scan. Only 1 of 77 patients without a history of RA was subsequently diagnosed with RA (1.3%, 95% CI 0.1-7.0%, median follow-up 3.6 years). Non-RA patients were significantly older (median age 79 v. 63 years, p Conclusion Patients without RA diagnosis and incidental atlanto-axial pannus on cervical spine MRI are unlikely to suffer from previously unrecognized RA. Degenerative disease and tissue calcification may contribute to pannus formation in these patients.