Cervical Myelopathy – A life-threatening complication of Rheumatoid Arthritis

Abstract

A middle-aged female with erosive Rheumatoid arthritis (RA) of ten years duration, presented in the emergency services with chronic neck pain, acute quadriparesis and respiratory distress. Cervical spine imaging showed anterior atlantoaxial subluxation (aAAS). She had a history of non-compliance to disease modifying antirheumatic drugs (DMARDs), doctor shopping, steroid use, avascular necrosis of hip, anemia, vitamin D deficiency, osteoporotic fracture and negative rheumatoid factor. Patient underwent C1 -C3 fixation with screws and bone grafting under general anesthesia (GA) but succumbed two weeks later due to ventilator - associated pneumonia. This case throws light on the rare but life-threatening, and preventable complication of RA affecting the atlantoaxial joint. It emphasizes the need for timely medical help-seeking, early initiation and long-term adherence to DMARDs in RA and hurdles encountered for the same. One must have a high index of suspicion for cervical spine involvement in long-standing and inadequately treated RA.