AB0329 CERVICAL SPINE INVOLVEMENT IN RHEUMATOID ARTHRITIS

Background After the small peripheral joints, the cervical spine is the second most involved region in rheumatoid arthritis (RA). The most frequent radiological features are the atlantoaxial subluxation (AAS) which can be anterior, posterior or vertical. During the course of the disease, the affection of the cervical spine has no symptoms for a long time due to the adaptability of neurological structures. The onset of myelopathy can occur at any time. MRI assessment compared to functional cervical spine X-ray is more sensitive method to provide not only AAS but also soft tissue involvement such as periodontal synovitis or fibrous pannus and even more odontoid erosion. New data show that there is a decreasing prevalence of cervical involvement because of the biologics. Objectives We assessed RA patients in permanent remission with MR imaging. RA patients have no cervical pain or any neurological symptoms. We wished to explore the cervical spine involvement: AAS, odontoid erosion or periodontal soft tissue thickening. We also wished to determine the affectation of cervical spine in RA patients receiving different treatment strategies. Methods Altogether 49 RA female patients were included. Among them, 15 were MTX-treated, biologic-free, 34 patients received biologics (17 infliximab [IFX] and 17 tocilizumab [TCZ]) as first-line biologic treatment, in combination with MTX. There was no significant difference between the main characteristics of these subgroups. ESR, CRP and DAS28 were determined in all RA patients in every 3 months. We calculated sumESR, sumCRP and sumDAS28 indices from the past 3 years. Results We detected anterior AAS in one-quarter of RA patients (13 affected patients from the total 49) (26,5%). There was no significant difference between the therapeutic subgroups. No posterior or vertical AAS occurred. Compared with patients without cervical involvement, the patients with AAS showed higher sumCRP and sumESR levels, higher sumDAS28 scores and more frequent seropositivity, but these differences were not significant. Soft tissue involvement of the cervical spine was detected in 33,3% of MTX-treated, in 35,3% of IFX-treated and in 5,9% of TCZ-treated RA patients. Eight RA patients had odontoid erosion (16,3%), 3 from the MTX, 2 from the IFX and 3 from the TCZ-treated subgroups. In relation to soft tissue involvement and odontoid erosion we did not find any correlation with age, disease duration, seropositivity, sumESR, sumCRP or sumDAS28 indices. Conclusion These findings suggest that the presence of cervical involvement in RA patients is an important and frequent phenomenon even in asymptomatic patients. Higher ACPA titer, high disease activity and erosive disease at baseline are predictors of atlantoaxial involvement. With the appropriate disease control with conventional or biologic treatment, progression of cervical spine involvement can also be prevented. References [1] The Craniovertebral Junction in Rheumatoid Arthritis: State of the Art. Ferrante A, Ciccia F, Giammalva GR, Iacopino DG, Visocchi M, Macaluso F, Maugeri R. Acta Neurochir Suppl. 2019;125:79-86. [2] Magnetic resonance imaging of the craniovertebral junction in early rheumatoid arthritis. Carotti M, Salaffi F, Di Carlo M, Sessa F, Giovagnoni A. Skeletal Radiol. 2018 Sep 11. Disclosure of Interests Zsofia Kardos: None declared, Csaba Olah: None declared, Laszlo Kostyal: None declared, Katalin Hodosi: None declared, Laszlo Tamasi: None declared, Zoltan Szekanecz Grant/research support from: Pfizer, UCB, Consultant for: Pfizer, Abbvie, Roche, Sanofi, Lilly, Novartis, Speakers bureau: Pfizer, Abbvie, Roche, Sanofi, Lilly, Novartis