Information Technology Reference
In-Depth Information
subluxation, atlanto-axial impaction, and subaxial subluxation. Atlanto-axial sub-
luxation is the separation of joint between the atlantis (the common name of C1, the
first cervical vertebra) and the axis (the common name of C2, the second cervical
vertebra). In
ammation of this joint leads to loosening of the surrounding ligaments,
which can permit a dynamic separation of this joint with
fl
flexion of the head. With
extensive subluxation, the superior part of C2 (known as the dens) can compress the
spinal cord when the head is
fl
flexed. Atlanto-axial impaction results when bone and
cartilage loss between the base of the skull and C1, and between C1 and C2, leads to
the superior migration of C2 relative to the skull. In severe cases, part of C2 can
penetrate the spinal cord opening at the base of the skull and compress the brainstem.
Because the brainstem controls vital functions such as respiration, compression may
result in death. Subaxial subluxation is the malalignment of vertebrae below C2, due
to chronic erosive joint in
fl
ammation and ligament instability. Atlanto-axial sub-
luxation is the most common cervical spine abnormality, occurring in up to 50 %.
Atlanto-axial impaction occurs in up to 40 %, while subaxial subluxation occurs in
10
fl
20 %. The thoracic spine and lumbar spine are typically not affected by RA.
Although RA primarily affects the joints, other parts of the body may be affected
by in
-
ammation due to RA, including the lungs or lung linings, the heart lining,
the outer surface of the eye, and blood-forming elements in the bone marrow.
Vasculitis, or in
fl
ammation of the blood vessels, may also occur.
The diagnosis of RA is based on a compatible clinical presentation, inflamma-
tion in many small joints on both the right and left sides, and the presence of
autoantibodies (either rheumatoid factor or antibodies to citrullinated proteins).
Blood tests indicating systemic in
fl
ammation, such as the C-reactive protein level,
are also often elevated. Radiographs that show bone erosions in typical locations
can also be helpful, but because these lesions take time to develop, they are often
not present at the start of symptoms.
fl
3.5.3 Treatment
The goal of RA treatment is prompt and complete control of joint in
ammation,
which will lessen symptoms, improve quality of life, and decrease the likelihood of
chronic joint damage and associated disability [ 71 ]. Medications therefore occupy
the central focus in RA treatment. While analgesics and NSAIDs such as naproxen
and ibuprofen can help lessen joint pain, they provide only temporary symptom
bene
fl
ammation, but
side effects preclude their chronic use. Appropriate treatment requires the long-term
use of one or more
t. Corticosteroids can also be bene
cial in controlling joint in
fl
disease-modifying
medications, which over time provide for
more sustained control of in
ammation and the potential to decrease the devel-
opment of joint damage [ 72 ]. Methotrexate, taken weekly in low doses, is the most
commonly used disease-modifying medication, based on evidence of sustained
ef
fl
cacy and generally good tolerability. Hydroxychloroquine, sulfasalazine, and
le
fl
unomide are other disease-modifying medications that can be used alone or in
Search WWH ::




Custom Search