Clinical and Radiological Assessment of Fluoroscopy Guided Injection of Atlantoaxial Joint in Rheumatoid Arthritis Patients

SONYA M. RASHAD, M.D., DOAA M. FOUAD, M.D.;; ABDELRAHEEM ELAWAMY, M.D., MONA S. GAILY, M.D.;; NISREEN ADEL ABASS, M.D., MANAL HASSANIEN, M.D.;

doi:10.21608/mjcu.2020.104871

Clinical and Radiological Assessment of Fluoroscopy Guided Injection of Atlantoaxial Joint in Rheumatoid Arthritis Patients

Document Type : Original Article

Authors

¹ The Departments of Anesthesia, Intensive Care & Pain Management, Rheumatology & Rehabilitation and Radiology, Faculty of Medicine, Assiut University

² The Department of Radiology, South Egypt Cancer Institute, Assiut University, The Department of Rheumatology and Rehabilitation, Faculty of Medicine, Suez University,

10.21608/mjcu.2020.104871

Abstract

Abstract Background: Rheumatoid spondylitis is a feature of long-lasting Rheumatoid Arthritis (RA), it presented by neck pain, headache and sleep disturbance. Atlantoaxial Joint (AAJ) is the commonest joint which affected among the cervical spine in patients with RA. When it is involved, it can be associated with dangerous complications. Aim of Study: This study aimed to evaluate the efficacy of intra-articular steroid injection of inflamed AAJ in RA patients, on neck pain, headache and sleep quality as well as the pre and post injection MRI assessment. Patients and Methods: Sixty rheumatoid arthritis patients with inflamed AAJ were recruited to the study. Group 1 (AAJ injected group, n=30), received intraarticular atlantoaxial steroid injection, guided by fluoroscopy and Group 2 (control group, n=30), received systemic steroids. Both groups were assessed with: Visual Analogue Scale (VAS) for nocturnal neck pain, Headache and Pittsburgh Sleep Quality Index (PSQI) for sleep disturbances. Contrast enhanced MRI before and after intervention were done for all patients. Results: The injected AAJ group had significant improve-ment of nocturnal neck pain, headache and sleep disturbance during the three months’ interval follow-up, in comparison to the control group. The injected AAJ group had a statistically significant improvement in the MRI synovial enhancement, inflammatory pannus, fibrosis and bone marrow edema in comparison to control group. Conclusion: Intra-articular steroid injection of atlantoaxial joint is considered as an efficient therapeutic option in acute inflamed atlantoaxial joint of RA patients regarding clinical and radiological findings.

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