Cervical Spine Change in Rheumatoid Arthritis

60-80% of patients with rheumatoid arthritis have cervical spine involvement. Manifestations include:

• atlantoaxial subluxation - do flexion/extension films, increased atlantodens interval
• multilevel, "stepladder" subluxations may be seen
• erosion of the dens
• calcified pannus around the dens is NOT rheumatoid arthritis - usually CPPD
• cranial settling - decreased distance from occiput to C2
• due to facet joint erosions
• spinous process erosions
• erosions at the foramen of Luschka

REFERENCES 
Sommer OJ, Kladosek A, Weiler V, et al. Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 2005;25:381-98.