Jose A. Narvaez MD, Abstract Co-Author: Nothing to Disclose

Matias De Albert, Presenter: Nothing to Disclose

Francisco Javier Narvaez MD, Abstract Co-Author: Nothing to Disclose

Eva Maria Merino MD, Abstract Co-Author: Nothing to Disclose

Eugenia De Lama MD, Abstract Co-Author: Nothing to Disclose

Joan Miquel Nolla-Sole MD, Abstract Co-Author: Nothing to Disclose

To investigate the frequency and location of bone marrow edema (BME) changes in patients with rheumatoid arthritis (RA) and symptomatic cervical spine involvement. Its possible relationship with clinical and outcome data is also explored.

Retrospective review of the medical charts and MR images of 19 patients studied with STIR sequences. Clinical and laboratory data included age, sex, disease duration, serum rheumatoid factor, acute phase reactants, Steinbrocker stage, presence of rheumatoid nodules or peripheral erosive disease, and clinical manifestations of compressive myelopathy categorized according to the Ranawat classification. Presence of bone marrow edema (BME), stenosis of the spinal canal, medullary compression and signs of myelopathy (i.e., high signal intensity on T2-weighted and/or STIR images) were analyzed at atlantoaxial level and subaxial spinal level (i.e., caudal to cervical spinal level C1-C2) on MR images. Presence of pannus, erosions and subluxations (anterior or superior) were analyzed at atlantoaxial level.

There were 15 women and 4 men, with a mean age of 59±13 years. Mean disease duration was 14±7.4 years, and most of the patients were seropositive (78.9%). Fourteen patients (73.7%) had BME in the cervical spine. BME was present at atlantoaxial level in 10 patients (52.6%), and in subaxial cervical spine in 10 patients (52.6%). Its presence correlated significantly with a shorter duration of RA (P = .033). In addition, BME at the atlantoaxial spine significantly correlated with ESR levels (P = .002). BME did not correlate with the presence of compressive myelopathy signs, spinal canal stenosis, medullary compression or myelopathy on MR images.

BME is a frequent finding in the cervical spine of symptomatic RA patients with shorter duration of the disease. Both, atlantoaxial and subaxial levels were equally affected. Atlantoaxial BME significantly correlates with the severity of the acute inflammatory parameters.

BME, known as a early marker of inflammation and as a predictor of bone erosion in the hand of RA, is also common in the cervical spine. Atlantoaxial BME correlates with acute inflammatory parameters.

Narvaez, J, De Albert, M, Narvaez, F, Merino, E, De Lama, E, Nolla-Sole, J, Bone Marrow Edema Changes in the Cervical Spine of Symptomatic Rheumatoid Arthritis Patients.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4426491.html