Severe rheumatoid arthritis of the temporomandibular joints and its coincidence with severe rheumatoid arthritis of the cervical spine

The degree of arthritis of the cervical spine was retrospectively studied in cervical spine radiographs from 400 patients with rheumatoid arthritis. In the same cervical radiographs the arthritic destruction of the temporomandibular joints was measured as diminished ramal height from the mandibular angle to the palato-occipital line. Reduced ramal height was found in 76 patients, 69 women and 7 men, and in 33 patients the reduction in height was severe enough to be compatible with a total destruction of the mandibular head. An arthritic destruction of the temporomandibular joints occurred significantly more often in patients with a severe cervical arthritis than in those without cervical affection, and vice versa. Of the 76 patients with a reduced ramal height, 66% had a severe arthritis of the cervical spine and of the 100 patients with severe arthritic changes of the cervical spine, 50% had severe destructive arthritis of the temporomandibular joints

Posterior atlanto-axial dislocation in rheumatoid arthritis

Seven patients with rheumatoid arthritis and posterior atlanto-axial dislocation are presented. The patients were elderly women who had suffered with the disease a long time. In all cases earlier cervical radiographs were available, excluding any predisposing congenital anomaly. Fracture and arthritic destruction of the dens, of parts of the body of the axis, or of the anterior arch of the atlas proved to be predisposing factors of the lesion

Atlanto-occipital dislocation in rheumatoid arthritis

Four cases of atlanto-occipital dislocation are described. Two of the cases were found in a material of 407 patients with rheumatoid arthritis indicating a frequency of 0.5 per cent. All the patients had severe mutilating changes of the peripheral joints as well as of the cervical spine and all developed severe neurologic symptoms. The diagnosis is not easy to set on conventional films so conventional tomography or rather computed tomography is recommended

Upper airway obstruction in patients with rheumatoid arthritis and temporomandibular joint destruction

Among 400 patients with rheumatoid arthritis and measurable ramus height there were 76 patients with mutilating arthritis of the temporomandibular joints. In 30 of these 400 patients, episodes of upper airway obstruction had occurred, mostly when the patient lay supine. Laryngoscopy had been performed in only 7 patients, and in 3 of those a laryngeal arthritis was detected. Upper airway obstruction had occurred significantly more often in patients with arthritis of the temporomandibular joints than in those with normal joints. In 70% of the patients with a severe arthritic destruction of the temporomandibular joints, episodes of airway obstruction had occurred. Upper airway obstruction is assumed to occur in those patients due to a pharyngeal obstruction, as in other patients with micrognathia or sleep apnea syndrome

Radiographic measurements of severe temporomandibular joint destruction at cervical radiography. Designed for evaluation in rheumatoid arthritis

Radiological examinations of the temporomandibular joints are not so often performed in patients with rheumatoid arthritis (RA). However, greater abnormalities of the mandibular head and neck may be evaluated at cervical radiography. With a new method, where the perpendicular distance from the palato-occipital line to the mandibular angle was measured, normal values of the distance or of ramal height were found to be above 27.5 mm in women and 33 mm in men. A significantly diminished ramal height was found in a patient material with RA compared with a normal material. Minor changes of the temporomandibular joints cannot be detected with this method, but severe arthritic destruction of the mandibular head or neck will give subnormal values

The costoclavicular joint

Two patients with a costoclavicular joint were discovered by chance during a survey of cervical spines. These seem to be the first to be described in the radiological literature. No other case was found in a further review of 500 consecutive spine radiographs. The costoclavicular joint is a variant of the ligamentous connection between the medial part of the clavicle and the first rib

Subaxial caudal dislocation of the cervical spine in rheumatoid arthritis

Subaxial (below the C 2) caudal dislocation is in the present study defined as a complete or partial dislocation caudally of a vertebral body (C 3 or below) into the plane of a lower vertebral body. In rheumatoid arthritis this dislocation is combined with erosive lesions of the vertebral bodies. In the present retrospective study seven such cases are presented. All were middle-aged or elderly women with a long history of disease and all also had a horizontal dislocation at the same level. Two patients had this dislocation at more than one level of the cervical spine and in two patients there was encroachment on the spinal canal. Most patients also had dislocations at the atlanto-axial level. Neurologic sequelae were rare