Neurological complications involving the cervical spine as a cause of adverse outcome in patients with rheumatoid arthritis

Rheumatoid arthritis (RA) is one of the most common autoimmune diseases. Erosive arthritis and pannus are key clinical features of RA, and the cervical spine (CS) involvement in RA is ranked 3rd in frequency after hand and foot joint involvement. Neurological complications in patients with the CS involvement significantly aggravate the course of RA and can cause an adverse outcome. Two clinical cases of RA patients with subluxation in the atlanto-occipital (AOJ) and atlanto-axial (AAJ) joints, pannus, and fatal outcome are presented. It was found that one of the first symptoms of AOJ and AAJ subluxations may be headache in the occipital region and pain in the upper cervical spine. The progression of instability in these joints leads first to transient and later persistent symptoms of involvement of the medulla oblongata and the cervical spinal cord. Early diagnosis of clinical manifestations, follow-up of radiological changes, and consultation with a neurosurgeon are important in these patients.