Rheumatoid arthritis is a multisystemic chronic inflammatory disease.
After hands and feet, the cervical spine is the third most commonly affected region by rheumatoid arthritis, in particular the atlantoaxial region.
Rheumatoid arthritis is characterized by autoantibody production, synovitis, secondary cartilage, and bone destruction.
Early diagnosis and prompt initiation of treatment are important to reduce structural damage and disability in patients with rheumatoid arthritis.
MRI is the modality of choice for early diagnosis of cervical involvement, thanks to its high sensitivity in detecting inflammatory changes in the joints (i.e., synovial changes, pannus formation, and bone marrow edema). At the same time, MRI can provide information about spinal cord, nerve roots, and epidural space. Moreover, MRI can document the craniocervical relationships and direct visualization of instability.
It is necessary to adopt a correct MRI study protocol of the cervical spine, which includes fat-suppressed T2-weighted or STIR images and, when indicated, fat-suppressed T1-weighted images after contrast medium administration.
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