TỶ LỆ TRẬT KHỚP ĐỘI TRỤC RA TRƯỚC TRÊN BỆNH NHÂN VIÊM KHỚP DẠNG THẤP TẠI BỆNH VIỆN NGUYỄN TRI PHƯƠNG

Abstract

Background: Anterior atlantoaxial subluxation is a serious complication of rheumatoid arthritis, potentially leading to severe neurological deficits and even death if not diagnosed and managed. However, in Vietnam, specific data on this condition remain limited. Objective: To determine the prevalence of anterior atlantoaxial subluxation on cervical spine radiographs in patients with rheumatoid arthritis. Method: A cross-sectional study was conducted at the Rheumatology Clinic of Nguyen Tri Phuong Hospital, from September 2024 to May 2025. Eligible participants were patients diagnosed with rheumatoid arthritis according to the 2010 EULAR/ACR classification criteria. Result: The study included 121 patients with rheumatoid arthritis. The mean age was 59.57 ± 11.05 years, with a female predominance (90,1%). The median disease duration was 8 years [IQR: 2.25–13.75], and the mean age at disease onset was 50.76 ± 12.42 years. The prevalence of anterior atlantoaxial subluxation on dynamic cervical spine radiographs was 22.3%, significantly higher than that of lateral radiographs (4.1%). Clinically, the percentage of patients with limb paresthesia and neck pain was 17,4% and 56,2% in turn. Notably, the proportion of limb paresthesia in anterior atlantoaxial subluxation group was significantly higher than that of non – subluxation group, at 44,4% and 9,6% correspondingly. This difference was statistically significant (p<0.001). The figure for patients with neck pain in the anterior atlantoaxial subluxation group was 70,4%, which was 18,3% higher than that for non – sublaxation group, but the difference was not statistically significant (p = 0.092). These findings suggest that limb paresthesia is a more specific indicator for anterior atlantoaxial subluxation than neck pain. Conclusion: The prevalence of anterior atlantoaxial subluxation on dynamic cervical spine radiographs in patients with rheumatoid arthritis was 22.3%, markedly higher than that of lateral radiographs (4.1%). This highlights the importance of dynamic cervical spine image in diagnosing anterior atlantoaxial subluxation. Clinically, while both neck pain and limb paresthesia are common, the latter is more strongly associated with the presence of subluxation (p < 0.001).