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. 1990 Apr;82(4):297-9, 302-4.

Sudden death in rheumatoid arthritis from vertical subluxation of the odontoid process.

D C Parish 1, J A Clark 1, S M Liebowitz 1, W C Hicks 1
PMCID: PMC2626114  PMID: 2332912

Abstract

Rheumatoid arthritis is a chronic, multisystem disease that causes significant morbidity and early mortality. A common source of morbidity in severe rheumatoid arthritis is involvement of the cervical spine. Sudden death due to subluxation of the odontoid process into the medulla oblongata is a dramatic but rare complication. We report the case of a patient who died suddenly. Computerized tomography scan, autopsy, and clinical findings were correlated. Studies of cervical involvement in rheumatoid arthritis were analyzed for cases of vertical subluxation. The case reports of sudden deaths and patients treated for vertical subluxation were reviewed; they revealed a trend toward surgery in patients with neurological abnormalities. However, a comparison of clinical outcome does not demonstrate improved survival with surgical intervention. Randomized trials comparing surgical with nonsurgical therapy are needed.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Awerbuch M. S., Henderson D. R., Milazzo S. C., White R. G., Utturkar A. B. Longterm follow-up of posterior cervical fusion for atlanto-axial subluxation in rheumatoid arthritis. J Rheumatol. 1981 May-Jun;8(3):423–432. [PubMed] [Google Scholar]
  2. Conlon P. W., Isdale I. C., Rose B. S. Rheumatoid arthritis of the cervical spine. An analysis of 333 cases. Ann Rheum Dis. 1966 Mar;25(2):120–126. doi: 10.1136/ard.25.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. DAVIS F. W., Jr, MARKLEY H. E. Rheumatoid arthritis with death from medullary compression. Ann Intern Med. 1951 Aug;35(2):451–454. doi: 10.7326/0003-4819-35-2-451. [DOI] [PubMed] [Google Scholar]
  4. Davidson R. C., Horn J. R., Herndon J. H., Grin O. D. Brain-stem compression in rheumatoid arthritis. JAMA. 1977 Dec 12;238(24):2633–2634. [PubMed] [Google Scholar]
  5. Henderson D. R. Vertical atlanto-axial subluxation in rheumatoid arthritis. Rheumatol Rehabil. 1975 Feb;14(1):31–38. doi: 10.1093/rheumatology/14.1.31. [DOI] [PubMed] [Google Scholar]
  6. Isdale I. C., Conlon P. W. Atlanto-axial subluxation. A six-year follow-up report. Ann Rheum Dis. 1971 Jul;30(4):387–389. doi: 10.1136/ard.30.4.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Kaiser M. C., Veiga-Pires J. A., Capesius P. Atlanto-axial impaction and compression of the medulla oblongata and proximal spinal cord in rheumatoid arthritis evaluated by CT scanning. Br J Radiol. 1983 Oct;56(670):764–766. doi: 10.1259/0007-1285-56-670-764. [DOI] [PubMed] [Google Scholar]
  8. Kankaanpä U., Santavirta S. Cervical spine involvement in rheumatoid arthritis. Ann Chir Gynaecol Suppl. 1985;198:117–121. [PubMed] [Google Scholar]
  9. Lipson S. J. Rheumatoid arthritis of the cervical spine. Clin Orthop Relat Res. 1984 Jan-Feb;(182):143–149. [PubMed] [Google Scholar]
  10. MARTEL W., PAGE J. W. Cervical vertebral erosions and subluxations in rheumatoid arthritis and ankylosing spondylitis. Arthritis Rheum. 1960 Dec;3:546–556. doi: 10.1002/art.1780030608. [DOI] [PubMed] [Google Scholar]
  11. Manz H. J., Luessenhop A. J., Robertson D. M. Cervical myelopathy due to atlantoaxial and subaxial subluxation in rheumatoid arthritis. Arch Pathol Lab Med. 1983 Feb;107(2):94–98. [PubMed] [Google Scholar]
  12. Marks J. S., Sharp J. Rheumatoid cervical myelopathy. Q J Med. 1981 Summer;50(199):307–319. [PubMed] [Google Scholar]
  13. Mathews J. A. Atlanto-axial subluxation in rheumatoid arthritis. A 5-year follow-up study. Ann Rheum Dis. 1974 Nov;33(6):526–531. doi: 10.1136/ard.33.6.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mathews J. A. Atlanto-axial subluxation in rheumatoid arthritis. Ann Rheum Dis. 1969 May;28(3):260–266. doi: 10.1136/ard.28.3.260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Mayer J. W., Messner R. P., Kaplan R. J. Brain stem compression in rheumatoid arthritis. JAMA. 1976 Nov 1;236(18):2094–2095. [PubMed] [Google Scholar]
  16. Mikulowski P., Wollheim F. A., Rotmil P., Olsen I. Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand. 1975 Dec;198(6):445–451. doi: 10.1111/j.0954-6820.1975.tb19573.x. [DOI] [PubMed] [Google Scholar]
  17. Nakano K. K., Schoene W. C., Baker R. A., Dawson D. M. The cervical myelopathy associated with rheumatoid arthritis: analysis of patients, with 2 postmortem cases. Ann Neurol. 1978 Feb;3(2):144–151. doi: 10.1002/ana.410030210. [DOI] [PubMed] [Google Scholar]
  18. Pellicci P. M., Ranawat C. S., Tsairis P., Bryan W. J. A prospective study of the progression of rheumatoid arthritis of the cervical spine. J Bone Joint Surg Am. 1981 Mar;63(3):342–350. [PubMed] [Google Scholar]
  19. Rana N. A., Hancock D. O., Taylor A. R., Hill A. G. Upward translocation of the dens in rheumatoid arthritis. J Bone Joint Surg Br. 1973 Aug;55(3):471–477. [PubMed] [Google Scholar]
  20. Ranawat C. S., O'Leary P., Pellicci P., Tsairis P., Marchisello P., Dorr L. Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am. 1979 Oct;61(7):1003–1010. [PubMed] [Google Scholar]
  21. Robinson H. S. Rheumatoid arthritis--atlanto-axial subluxation and its clinical presentation. Can Med Assoc J. 1966 Mar 5;94(10):470–477. [PMC free article] [PubMed] [Google Scholar]
  22. STOREY G. Changes in the cervical spine in rheumatoid arthritis with compression of the cord; with reports of four cases. Ann Phys Med. 1958 May;4(6):216–218. doi: 10.1093/rheumatology/iv.6.216. [DOI] [PubMed] [Google Scholar]
  23. Smith H. P., Challa V. R., Alexander E., Jr Odontoid compression of the brain stem in a patient with rheumatoid arthritis. Case report. J Neurosurg. 1980 Dec;53(6):841–845. doi: 10.3171/jns.1980.53.6.0841. [DOI] [PubMed] [Google Scholar]
  24. Smith P. H., Benn R. T., Sharp J. Natural history of rheumatoid cervical luxations. Ann Rheum Dis. 1972 Nov;31(6):431–439. doi: 10.1136/ard.31.6.431. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Weissman B. N., Aliabadi P., Weinfeld M. S., Thomas W. H., Sosman J. L. Prognostic features of atlantoaxial subluxation in rheumatoid arthritis patients. Radiology. 1982 Sep;144(4):745–751. doi: 10.1148/radiology.144.4.7111719. [DOI] [PubMed] [Google Scholar]

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