Among patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) complaining of neck pain, bone marrow edema (BME) was present in the cervical spine on magnetic resonance imaging (MRI), according to a study published in The Journal of Rheumatology.

“Neck pain in patients with AS or RA is common and may not just be due to muscle issues, but also due to inflammatory activity in the cervical spine,” Xenofon Baraliakos, MD, of Rheumazentrum Ruhrgebiet, in Herne, Germany, told Rheumatology Advisor.

To what extent neck pain correlates with BME on cervical spine MRI remains unclear. Imaging of the cervical spine with MRI in RA and AS has not been extensively studied, and established RA disease activity scores do not adequately identify inflammation in the cervical spine. An MRI score that measures BME, synovitis, and erosions in the cervical spine has been proposed to provide more clinical utility for detecting cervical spine pathology.


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Dr Baraliakos and colleagues examined the association between neck pain and cervical spine BME in patients with RA and AS who participated in the earlier CASSANDRA (Cervical ArthritiS Scoring AND Treatment in Rheumatoid Arthritis) trial, which analyzed the frequency and severity of neck pain in patients with RA and AS.

Cervical spine MRIs from 34 patients with RA and 6 patients with AS were scored for BME by 2 blinded readers using a modified version of the published MRI scoring system.

BME was present in the majority (60%) of patients and was most commonly found in vertebral bodies (75%) and spinous processes (45.8%). Other sites affected by BME included facet joints (29.2%) and the atlantoaxial region (20.8%).

A total of 52.5% of patients had degenerative changes and, of these, 62% also had BME in vertebral bodies.

Clinical symptoms of neck pain, as measured by pain scores, did not differ between patients with cervical BME lesions and patients without.

“Clinicians who treat patients with RA and AS with persistent neck pain should consider obtaining an MRI of the cervical spine,” Dr Baraliakos stated. “Should inflammation remain undiscovered in these patients, it may lead to bony erosions that cause instability of the neck and lead to neurological problems or sudden death due to spinal cord compression.”

Summary and Clinical Applicability

Neck pain is common in patients with RA and AS and may be caused by BME. In this prospective study, the authors evaluated the relationship between neck pain and BME on cervical spine MRI in patients with RA and AS.

“In this small study of patients with RA and AS complaining about neck pain, BME was found in many different cervical sites, including the facet joints and the spinous processes. However, the occurrence and severity of BME did not correlate with the severity of neck pain,” the authors wrote.

Limitations and Disclosures

  • The study population consisted of mostly patients with RA and only included a small number of patients with AS Ÿ  
  • Cervical spine MRI was performed only using standard protocols, so it is unknown whether obtaining flexion views would better capture inflammatory changes in the subarachnoid space in patients with RA

This study was funded by a research grant from Pfizer Germany.

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Reference

Baraliakos X, Heldmann F, Callhoff J, et al. Quantification of bone marrow edema by magnetic resonance imaging only marginally reflects clinical neck pain evaluation in rheumatoid arthritis and ankylosing spondylitis. J Rheumatol 2016 Oct 15. doi: 10.3899/jrheum.150553 [Epub ahead of print] 

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