array:23 [
  "pii" => "S2173574307702514"
  "issn" => "21735743"
  "doi" => "10.1016/S2173-5743(07)70251-4"
  "estado" => "S300"
  "fechaPublicacion" => "2007-09-01"
  "aid" => "70251"
  "copyright" => "Sociedad Española de Reumatología and Colegio Mexicano de Reumatología"
  "copyrightAnyo" => "2007"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Reumatol Clin. 2007;3:213-7"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1979
    "formatos" => array:3 [
      "EPUB" => 35
      "HTML" => 1322
      "PDF" => 622
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173574307702526"
    "issn" => "21735743"
    "doi" => "10.1016/S2173-5743(07)70252-6"
    "estado" => "S300"
    "fechaPublicacion" => "2007-09-01"
    "aid" => "70252"
    "copyright" => "Sociedad Española de Reumatología and Colegio Mexicano de Reumatología"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2007;3:218-25"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2094
      "formatos" => array:3 [
        "EPUB" => 51
        "HTML" => 1620
        "PDF" => 423
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Asistance Quality Standards in Rheumatology"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "218"
          "paginaFinal" => "225"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estándares de calidad asistencial en reumatología"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto Alonso Ruiz, Javier Vidal Fuentes, Jesús Tornero Molina, Jordi Carbonell Abelló, Pablo Lázaro y de Mercado, M. Dolores Aguilar Conesa"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "Alonso Ruiz"
            ]
            1 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Vidal Fuentes"
            ]
            2 => array:2 [
              "nombre" => "Jesús"
              "apellidos" => "Tornero Molina"
            ]
            3 => array:2 [
              "nombre" => "Jordi"
              "apellidos" => "Carbonell Abelló"
            ]
            4 => array:2 [
              "nombre" => "Pablo Lázaro"
              "apellidos" => "y de Mercado"
            ]
            5 => array:2 [
              "nombre" => "M."
              "apellidos" => "Dolores Aguilar Conesa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574307702526?idApp=UINPBA00004M"
    "url" => "/21735743/0000000300000005/v1_201305061537/S2173574307702526/v1_201305061537/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173574307702502"
    "issn" => "21735743"
    "doi" => "10.1016/S2173-5743(07)70250-2"
    "estado" => "S300"
    "fechaPublicacion" => "2007-09-01"
    "aid" => "70250"
    "copyright" => "Sociedad Española de Reumatología and Colegio Mexicano de Reumatología"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Reumatol Clin. 2007;3:204-12"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1755
      "formatos" => array:3 [
        "EPUB" => 42
        "HTML" => 1178
        "PDF" => 535
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Meta-Analysis of Efficacy of Anti-TNF Alpha Therapy in Ankylosing Spondylitis Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "204"
          "paginaFinal" => "212"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Metaanálisis de la eficacia del tratamiento con anti-TNF alfa en pacientes con espondilitis anquilosante"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan Montilla Salas, Elisa Muñoz Gomáriz, Eduardo Collantes"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Juan"
              "apellidos" => "Montilla Salas"
            ]
            1 => array:2 [
              "nombre" => "Elisa"
              "apellidos" => "Muñoz Gomáriz"
            ]
            2 => array:2 [
              "nombre" => "Eduardo"
              "apellidos" => "Collantes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574307702502?idApp=UINPBA00004M"
    "url" => "/21735743/0000000300000005/v1_201305061537/S2173574307702502/v1_201305061537/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Neurophysiologic Study in Patients With Rheumatoid Arthritis With Atlantoaxial Subluxation"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "213"
        "paginaFinal" => "217"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Antonio Juan, José Valverde, Mónica Veciana, Jorge Montero"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Antonio"
            "apellidos" => "Juan"
            "email" => array:1 [
              0 => "ajuan@hsll.es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Jos&#233;"
            "apellidos" => "Valverde"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#243;nica"
            "apellidos" => "Veciana"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jorge"
            "apellidos" => "Montero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Unidad de Reumatolog&#237;a&#44; Hospital Son Ll&#224;tzer&#44; Palma de Mallorca&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Reumatolog&#237;a&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Unidad Neuromuscular&#44; Servicio de Neurolog&#237;a&#44; Hospital Universitari de Bellvitge&#44; L&#8217;Hospitalet de Llobregat&#44; Barcelona&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondence&#58; Unidad de Reumatolog&#237;a&#46; Hospital Son Ll&#224;tzer&#46; Ctra&#46; Manacor&#44; km 4&#46; 07198 Palma de Mallorca&#46; Espa&#241;a&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Estudio neurofisiol&#243;gico en pacientes con artritis reumatoide y subluxaci&#243;n atloaxoidea"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2007-03-03"
    "fechaAceptado" => "2007-07-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec111565"
          "palabras" => array:3 [
            0 => "Rheumatoid arthritis"
            1 => "Cervical spine"
            2 => "Neurophysiologic studies"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec111564"
          "palabras" => array:3 [
            0 => "Artritis reumatoide"
            1 => "Columna cervical"
            2 => "Estudios neurofisiol&#243;gicos"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Radiological studies show that 80&#37; of rheumatoid arthritis &#40;RA&#41; patients with more than 10 years present spinal afflictions and 40&#37; of those patients will present neurological deterioration&#46; The somatesthetic evoked potential &#40;SEP&#41; and the transcortical magnetic stimulation &#40;TMS&#41; are neurophysiologic studies that may be useful in early diagnosis of neurological damage&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To compare the results of the neurophysiologic studies &#40;SEP and TMS&#41; carried out on patients affected with RA without neurological clinic&#44; with or without atlantoaxial subluxation &#40;AAS&#41;&#44; and in this way evaluate the efficacy of early diagnosis of the affection of the spinal medulla by electrodiagnostic methods&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases and controls study that included 29 patients affected with RA of more than 3 years evolution&#46; All of the patients had 2 electrophysiological techniques carried out on them&#58; SEP and TMS in the neurophysiologic laboratory&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Twenty-nine patients participated in the study&#44; of which 21 were females and 8 males&#46; In the group affected with AAS 2 patients presented anomaly in the SEP &#40;11&#46;7&#37;&#41; and 7 in the TMS &#40;41&#46;1&#37;&#41;&#46; In the group without AAS 2 presented an altered TMS &#40;16&#46;6&#37;&#41;&#44; but no alteration in the SEP&#46; No patient affected or not with AAS&#44; presented alteration of both electrophysiological tests&#46; No significant differences were found between the positivity of the RF or the presence of erosions and the affection of the atlantoaxial joint&#46; No differences between the age of outset or years of evolution and the AAS&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In our study patients with AAS showed a greater trend towards the presence of alterations in the electrophysiological studies than the patients without AAS&#46;</p>"
      ]
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los estudios radiol&#243;gicos demuestran que el 80&#37; de los pacientes afectos de artritis reumatoide con m&#225;s de 10 a&#241;os de evoluci&#243;n presentan afectaci&#243;n cervical y que el 40&#37; de ellos presentaba deterioro neurol&#243;gico&#46; Los potenciales evocados somest&#233;sicos &#40;PES&#41; y la estimulaci&#243;n magn&#233;tica transcortical &#40;PEM&#41; son estudios neurofisiol&#243;gicos que pueden ser &#250;tiles para un diagn&#243;stico precoz de da&#241;o neurol&#243;gico&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Comparar los resultados de los estudios neurofisiol&#243;gicos &#40;PES y PEM&#41; practicados a pacientes afectos de artiritis reumatoide sin cl&#237;nica neurol&#243;gica&#44; con y sin subluxaci&#243;n atloaxoidea &#40;SAA&#41;&#44; y valorar la eficacia del diagn&#243;stico precoz de la afecci&#243;n de la m&#233;dula espinal por m&#233;todos de electrodiagn&#243;stico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio de casos y controles que ha incluido a 29 pacientes afectos de artritis reumatoide de m&#225;s de 3 a&#241;os de evoluci&#243;n&#46; A todos los pacientes se les han practicado 2 t&#233;cnicas electofisiol&#243;gicas&#58; PES y PEM en el laboratorio de neurofisiolog&#237;a y se han separado los dos grupos seg&#250;n presentaran o no SAA&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Participaron en el estudio 29 pacientes&#44; 21 mujeres y 8 varones&#46; En el grupo con SAA&#44; 2 pacientes presentaron una anomal&#237;a en el PES &#40;11&#44;7&#37;&#41; y 7 en la PEM &#40;41&#44;1&#37;&#41;&#46; En el grupo sin SAA 2 presentaron una PEM alterada &#40;16&#44;6&#37;&#41; y ninguno alteraci&#243;n en el PES&#46; Ning&#250;n paciente&#44; afecto o no de SAA&#44; present&#243; alteraci&#243;n de ambas pruebas electrofisiol&#243;gicas&#46; No se encontraron diferencias significativas entre la positividad del factor reumatoide o la presencia de erosiones y la afectaci&#243;n de la articulaci&#243;n atloaxoidea&#46; Tampoco se encontraron diferencias entre la edad de presentaci&#243;n o los a&#241;os de evoluci&#243;n y la SAA&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En nuestro estudio los pacientes con SAA mostraron una mayor tendencia a presentar alteraciones en los estudios neurofisiol&#243;gicos que los pacientes sin SAA&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Postmorten osseous and neuropathologic analysis of the rheumatoid cervical spine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;B&#46; Delamarter"
                            1 => "H&#46;H&#46; Bohlman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Spine&#46;"
                        "fecha" => "1994"
                        "volumen" => "19"
                        "paginaInicial" => "2267"
                        "paginaFinal" => "2274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7846570"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611619314"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Natural course of cervical spine lesions in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46; Oda"
                            1 => "K&#46; Fujiwara"
                            2 => "K&#46; Yonenobu"
                            3 => "B&#46; Azuma"
                            4 => "T&#46; Ochi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine&#46;"
                        "fecha" => "1995"
                        "volumen" => "20"
                        "paginaInicial" => "1128"
                        "paginaFinal" => "1135"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7638655"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide simple of rheumatoid artritis patients"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "EMECAR Study-Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Naranjo"
                            1 => "L&#46; Carmona"
                            2 => "D&#46; Gavrila"
                            3 => "A&#46; Balsa"
                            4 => "M&#46;A&#46; Belmonte"
                            5 => "X&#46; Tena"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Rheumatol"
                        "fecha" => "2004"
                        "volumen" => "22"
                        "paginaInicial" => "427"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15301239"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of cervical spine subluxations and dislocations in a community-based rheumatoid arthritis population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Kauppi"
                            1 => "M&#46; Hakala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatology&#46;"
                        "fecha" => "1994"
                        "volumen" => "23"
                        "paginaInicial" => "133"
                        "paginaFinal" => "136"
                        "itemHostRev" => array:3 [
                          "pii" => "S0300893211008311"
                          "estado" => "S300"
                          "issn" => "03008932"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of peripheral and shoulder joints&#44; and decreased bone mineral density"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Neva"
                            1 => "A&#46; Kotaniemi"
                            2 => "K&#46; Kaarela"
                            3 => "J&#46;T&#46; Lehtinen"
                            4 => "E&#46;A&#46; Belt"
                            5 => "M&#46; Kauppi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Rheumatol&#46;"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "179"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12747271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Neva"
                            1 => "P&#46; Isomaki"
                            2 => "P&#46; Hannonen"
                            3 => "M&#46; Kauppi"
                            4 => "E&#46; Krishnan"
                            5 => "T&#46; Sokka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.11085"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum&#46;"
                        "fecha" => "2003"
                        "volumen" => "48"
                        "paginaInicial" => "1775"
                        "paginaFinal" => "1778"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12847668"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progression of cervical spine changes in patients with early rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Paimela"
                            1 => "L&#46; Laasonen"
                            2 => "E&#46; Kankaanp&#228;&#228;"
                            3 => "M&#46; Leirisalo-Repo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol&#46;"
                        "fecha" => "1997"
                        "volumen" => "24"
                        "paginaInicial" => "1280"
                        "paginaFinal" => "1284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9228125"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Review of the spinal complications of rheumatoid disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Johnston"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neurosurg Q&#46;"
                        "fecha" => "1988"
                        "volumen" => "8"
                        "paginaInicial" => "206"
                        "paginaFinal" => "215"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient-too much&#44; too late&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;T&#46;H&#46; Casey"
                            1 => "H&#46;A&#46; Crockard"
                            2 => "M&#46; Bland"
                            3 => "J&#46; Stevens"
                            4 => "R&#46; Moskovich"
                            5 => "A&#46;O&#46; Ransford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "1996"
                        "volumen" => "347"
                        "paginaInicial" => "1004"
                        "paginaFinal" => "1007"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8606562"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Riise"
                            1 => "B&#46;K&#46; Jacobsen"
                            2 => "J&#46;T&#46; Gran"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol&#46;"
                        "fecha" => "2001"
                        "volumen" => "28"
                        "paginaInicial" => "2425"
                        "paginaFinal" => "2429"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11708413"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality associated with cervical spine disorders&#58; a population-based study of 1&#44;666 patients with rheumatoid arthritis who died in Finland in 1989"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;H&#46; Neva"
                            1 => "R&#46; Myllykangas-Luosuj&#228;rvi"
                            2 => "H&#46; Kautiainen"
                            3 => "M&#46; Kauppi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology&#46;"
                        "fecha" => "2001"
                        "volumen" => "40"
                        "paginaInicial" => "123"
                        "paginaFinal" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11257146"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spine involvement in rheumatoid arthritis&#58; a clinical&#44; neurological and radiological evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Castro"
                            1 => "K&#46; Vestraete"
                            2 => "H&#46; Mielants"
                            3 => "G&#46; Vanderstraeten"
                            4 => "J&#46; de Reuck"
                            5 => "E&#46;M&#46; Veys"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp Rheumatol&#46;"
                        "fecha" => "1994"
                        "volumen" => "12"
                        "paginaInicial" => "369"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7955599"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;D&#46; Hamilton"
                            1 => "R&#46;A&#46; Johnston"
                            2 => "R&#46; Madhok"
                            3 => "H&#46;A&#46; Capell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatology&#46;"
                        "fecha" => "2001"
                        "volumen" => "40"
                        "paginaInicial" => "811"
                        "paginaFinal" => "815"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11477287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis of the craniocervical region by MR imaging&#58; Detection and characterization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Stiskal"
                            1 => "A&#46; Neuhold"
                            2 => "D&#46;H&#46; Szolar"
                            3 => "M&#46; Saeed"
                            4 => "C&#46; Czerny"
                            5 => "B&#46; Leeb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.165.3.7645475"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol&#46;"
                        "fecha" => "1995"
                        "volumen" => "165"
                        "paginaInicial" => "585"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7645475"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of cervical spine inflammatory arthritis with somatosensory evoked potentials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;M&#46; Katz"
                            1 => "H&#46;A&#46; Emsellem"
                            2 => "D&#46;G&#46; Borenstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol&#46;"
                        "fecha" => "1990"
                        "volumen" => "17"
                        "paginaInicial" => "508"
                        "paginaFinal" => "514"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2348432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Somatosensory evoked potentials &#40;SSEPs&#41; in rheumatoid cervical subluxation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Toolanen"
                            1 => "M&#46; Knibestol"
                            2 => "S&#46;E&#46; Larsson"
                            3 => "K&#46; Landman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol&#46;"
                        "fecha" => "1987"
                        "volumen" => "16"
                        "paginaInicial" => "17"
                        "paginaFinal" => "25"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3589587"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Three dimensional CT evaluation of occipito-atlantoaxial dislocation in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Ostensen"
                            1 => "T&#46;E&#46; Gudmundsen"
                            2 => "M&#46; Haakonsen"
                            3 => "H&#46; Lagerqvist"
                            4 => "C&#46; Kaufmann"
                            5 => "M&#46; Ostensen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol&#46;"
                        "fecha" => "1998"
                        "volumen" => "27"
                        "paginaInicial" => "352"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9808398"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early diagnosis of rheumatoid cervical myelopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Babic-Naglic"
                            1 => "Nesek-Madaric"
                            2 => "K&#46; Potocki"
                            3 => "N&#46; Lelas-Bahun"
                            4 => "B&#46; Curkovic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Rheumatol&#46;"
                        "fecha" => "1997"
                        "volumen" => "26"
                        "paginaInicial" => "247"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9310102"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are somatosensory evoked potential recording and magnetic resonance imaging useful for evaluating the risk of neurologic compromise in rheumatoid arthritis patients with atlantoaxial subluxation&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "O&#46; Cartry"
                            1 => "P&#46; Collet"
                            2 => "P&#46; Convers"
                            3 => "F&#46;G&#46; Barral"
                            4 => "D&#46; Michel"
                            5 => "C&#46; Alexandre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Rhum Engl Ed&#46;"
                        "fecha" => "1996"
                        "volumen" => "63"
                        "paginaInicial" => "584"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8938867"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Kauppi"
                            1 => "L&#46; Lepp&#228;nen"
                            2 => "S&#46; Heikkil&#228;"
                            3 => "T&#46; Lahtinen"
                            4 => "H&#46; Kautiainen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Rheumatol&#46;"
                        "fecha" => "1998"
                        "volumen" => "37"
                        "paginaInicial" => "417"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9619893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spine surgery in patients with rheumatoid arthritis&#58; an appraisal"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;R&#46; McRorie"
                            1 => "P&#46; McLoughlin"
                            2 => "T&#46; Russell"
                            3 => "I&#46; Beggs"
                            4 => "G&#46; Nuki"
                            5 => "N&#46;P&#46; Hurst"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis&#46;"
                        "fecha" => "1996"
                        "volumen" => "55"
                        "paginaInicial" => "99"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8712874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cervical spine surgery in rheumatoid arthritis&#58; improvement of neurologic deficit after cervical spine fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;C&#46; Peppelman"
                            1 => "D&#46;C&#46; Kraus"
                            2 => "W&#46;F&#46; Donaldson"
                            3 => "A&#46; Agarwal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine&#46;"
                        "fecha" => "1993"
                        "volumen" => "18"
                        "paginaInicial" => "2375"
                        "paginaFinal" => "2379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8303435"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy&#44; reduction of subluxation&#44; and stabilisation of the cervical spine&#46; A report of 2 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;C&#46;M&#46; Oostveen"
                            1 => "A&#46;F&#46;J&#46; van de Laar"
                            2 => "J&#46;A&#46;G&#46; Geelen"
                            3 => "R&#46; Graaff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Rheum Dis&#46;"
                        "fecha" => "1999"
                        "volumen" => "58"
                        "paginaInicial" => "126"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10343530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurologic involvement in patients with rheumatoid arthritis with atlantoaxial subluxation &#8211; a clinical and neurophysiological study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Rosa"
                            1 => "M&#46; Alves"
                            2 => "M&#46;V&#46; Queir&#243;s"
                            3 => "F&#46; Morgado"
                            4 => "A&#46; Mendoza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Rheumatol&#46;"
                        "fecha" => "1993"
                        "volumen" => "20"
                        "paginaInicial" => "48"
                        "paginaFinal" => "52"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735743/0000000300000005/v1_201305061537/S2173574307702514/v1_201305061537/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "17338"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Original Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000300000005/v1_201305061537/S2173574307702514/v1_201305061537/en/main.pdf?idApp=UINPBA00004M&text.app=https://www.reumatologiaclinica.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574307702514?idApp=UINPBA00004M"
]
Share
Journal Information
Vol. 3. Issue 5.
Pages 213-217 (September - October 2007)
Share
Share
Download PDF
More article options
Vol. 3. Issue 5.
Pages 213-217 (September - October 2007)
Full text access
Neurophysiologic Study in Patients With Rheumatoid Arthritis With Atlantoaxial Subluxation
Estudio neurofisiológico en pacientes con artritis reumatoide y subluxación atloaxoidea
Visits
5141
Antonio Juana,
Corresponding author
ajuan@hsll.es

Correspondence: Unidad de Reumatología. Hospital Son Llàtzer. Ctra. Manacor, km 4. 07198 Palma de Mallorca. España.
, José Valverdeb, Mónica Vecianac, Jorge Monteroc
a Unidad de Reumatología, Hospital Son Llàtzer, Palma de Mallorca, Spain
b Servicio de Reumatología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
c Unidad Neuromuscular, Servicio de Neurología, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Introduction

Radiological studies show that 80% of rheumatoid arthritis (RA) patients with more than 10 years present spinal afflictions and 40% of those patients will present neurological deterioration. The somatesthetic evoked potential (SEP) and the transcortical magnetic stimulation (TMS) are neurophysiologic studies that may be useful in early diagnosis of neurological damage.

Objective

To compare the results of the neurophysiologic studies (SEP and TMS) carried out on patients affected with RA without neurological clinic, with or without atlantoaxial subluxation (AAS), and in this way evaluate the efficacy of early diagnosis of the affection of the spinal medulla by electrodiagnostic methods.

Material and methods

Cases and controls study that included 29 patients affected with RA of more than 3 years evolution. All of the patients had 2 electrophysiological techniques carried out on them: SEP and TMS in the neurophysiologic laboratory.

Results

Twenty-nine patients participated in the study, of which 21 were females and 8 males. In the group affected with AAS 2 patients presented anomaly in the SEP (11.7%) and 7 in the TMS (41.1%). In the group without AAS 2 presented an altered TMS (16.6%), but no alteration in the SEP. No patient affected or not with AAS, presented alteration of both electrophysiological tests. No significant differences were found between the positivity of the RF or the presence of erosions and the affection of the atlantoaxial joint. No differences between the age of outset or years of evolution and the AAS.

Conclusions

In our study patients with AAS showed a greater trend towards the presence of alterations in the electrophysiological studies than the patients without AAS.

Key words:
Rheumatoid arthritis
Cervical spine
Neurophysiologic studies
Introducción

Los estudios radiológicos demuestran que el 80% de los pacientes afectos de artritis reumatoide con más de 10 años de evolución presentan afectación cervical y que el 40% de ellos presentaba deterioro neurológico. Los potenciales evocados somestésicos (PES) y la estimulación magnética transcortical (PEM) son estudios neurofisiológicos que pueden ser útiles para un diagnóstico precoz de daño neurológico.

Objetivo

Comparar los resultados de los estudios neurofisiológicos (PES y PEM) practicados a pacientes afectos de artiritis reumatoide sin clínica neurológica, con y sin subluxación atloaxoidea (SAA), y valorar la eficacia del diagnóstico precoz de la afección de la médula espinal por métodos de electrodiagnóstico.

Material y métodos

Se trata de un estudio de casos y controles que ha incluido a 29 pacientes afectos de artritis reumatoide de más de 3 años de evolución. A todos los pacientes se les han practicado 2 técnicas electofisiológicas: PES y PEM en el laboratorio de neurofisiología y se han separado los dos grupos según presentaran o no SAA.

Resultados

Participaron en el estudio 29 pacientes, 21 mujeres y 8 varones. En el grupo con SAA, 2 pacientes presentaron una anomalía en el PES (11,7%) y 7 en la PEM (41,1%). En el grupo sin SAA 2 presentaron una PEM alterada (16,6%) y ninguno alteración en el PES. Ningún paciente, afecto o no de SAA, presentó alteración de ambas pruebas electrofisiológicas. No se encontraron diferencias significativas entre la positividad del factor reumatoide o la presencia de erosiones y la afectación de la articulación atloaxoidea. Tampoco se encontraron diferencias entre la edad de presentación o los años de evolución y la SAA.

Conclusiones

En nuestro estudio los pacientes con SAA mostraron una mayor tendencia a presentar alteraciones en los estudios neurofisiológicos que los pacientes sin SAA.

Palabras clave:
Artritis reumatoide
Columna cervical
Estudios neurofisiológicos
Full text is only aviable in PDF
References
[1.]
R.B. Delamarter, H.H. Bohlman.
Postmorten osseous and neuropathologic analysis of the rheumatoid cervical spine.
Spine., 19 (1994), pp. 2267-2274
[2.]
T. Oda, K. Fujiwara, K. Yonenobu, B. Azuma, T. Ochi.
Natural course of cervical spine lesions in rheumatoid arthritis.
Spine., 20 (1995), pp. 1128-1135
[3.]
A. Naranjo, L. Carmona, D. Gavrila, A. Balsa, M.A. Belmonte, X. Tena, EMECAR Study-Group, et al.
Prevalence and associated factors of anterior atlantoaxial luxation in a nation-wide simple of rheumatoid artritis patients.
Clin Exp Rheumatol, 22 (2004), pp. 427-432
[4.]
M. Kauppi, M. Hakala.
Prevalence of cervical spine subluxations and dislocations in a community-based rheumatoid arthritis population.
Scand J Rheumatology., 23 (1994), pp. 133-136
[5.]
M.H. Neva, A. Kotaniemi, K. Kaarela, J.T. Lehtinen, E.A. Belt, M. Kauppi.
Atlantoaxial disorders in rheumatoid arthritis associate with the destruction of peripheral and shoulder joints, and decreased bone mineral density.
Clin Exp Rheumatol., 21 (2003), pp. 179-184
[6.]
M.H. Neva, P. Isomaki, P. Hannonen, M. Kauppi, E. Krishnan, T. Sokka.
Early and extensive erosiveness in peripheral joints predicts atlantoaxial subluxations in patients with rheumatoid arthritis.
Arthritis Rheum., 48 (2003), pp. 1775-1778
[7.]
L. Paimela, L. Laasonen, E. Kankaanpää, M. Leirisalo-Repo.
Progression of cervical spine changes in patients with early rheumatoid arthritis.
J Rheumatol., 24 (1997), pp. 1280-1284
[8.]
R.A. Johnston.
Review of the spinal complications of rheumatoid disease.
Neurosurg Q., 8 (1988), pp. 206-215
[9.]
A.T.H. Casey, H.A. Crockard, M. Bland, J. Stevens, R. Moskovich, A.O. Ransford.
Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient-too much, too late?.
Lancet., 347 (1996), pp. 1004-1007
[10.]
T. Riise, B.K. Jacobsen, J.T. Gran.
High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation.
J Rheumatol., 28 (2001), pp. 2425-2429
[11.]
M.H. Neva, R. Myllykangas-Luosujärvi, H. Kautiainen, M. Kauppi.
Mortality associated with cervical spine disorders: a population-based study of 1,666 patients with rheumatoid arthritis who died in Finland in 1989.
Rheumatology., 40 (2001), pp. 123-127
[12.]
S. Castro, K. Vestraete, H. Mielants, G. Vanderstraeten, J. de Reuck, E.M. Veys.
Cervical spine involvement in rheumatoid arthritis: a clinical, neurological and radiological evaluation.
Clin Exp Rheumatol., 12 (1994), pp. 369-374
[13.]
J.D. Hamilton, R.A. Johnston, R. Madhok, H.A. Capell.
Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy.
Rheumatology., 40 (2001), pp. 811-815
[14.]
M.A. Stiskal, A. Neuhold, D.H. Szolar, M. Saeed, C. Czerny, B. Leeb, et al.
Rheumatoid arthritis of the craniocervical region by MR imaging: Detection and characterization.
AJR Am J Roentgenol., 165 (1995), pp. 585-592
[15.]
L.M. Katz, H.A. Emsellem, D.G. Borenstein.
Evaluation of cervical spine inflammatory arthritis with somatosensory evoked potentials.
J Rheumatol., 17 (1990), pp. 508-514
[16.]
G. Toolanen, M. Knibestol, S.E. Larsson, K. Landman.
Somatosensory evoked potentials (SSEPs) in rheumatoid cervical subluxation.
Scand J Rheumatol., 16 (1987), pp. 17-25
[17.]
H. Ostensen, T.E. Gudmundsen, M. Haakonsen, H. Lagerqvist, C. Kaufmann, M. Ostensen.
Three dimensional CT evaluation of occipito-atlantoaxial dislocation in rheumatoid arthritis.
Scand J Rheumatol., 27 (1998), pp. 352-356
[18.]
D. Babic-Naglic, Nesek-Madaric, K. Potocki, N. Lelas-Bahun, B. Curkovic.
Early diagnosis of rheumatoid cervical myelopathy.
Scand J Rheumatol., 26 (1997), pp. 247-252
[19.]
O. Cartry, P. Collet, P. Convers, F.G. Barral, D. Michel, C. Alexandre.
Are somatosensory evoked potential recording and magnetic resonance imaging useful for evaluating the risk of neurologic compromise in rheumatoid arthritis patients with atlantoaxial subluxation?.
Rev Rhum Engl Ed., 63 (1996), pp. 584-592
[20.]
M. Kauppi, L. Leppänen, S. Heikkilä, T. Lahtinen, H. Kautiainen.
Active conservative treatment of atlantoaxial subluxation in rheumatoid arthritis.
Br J Rheumatol., 37 (1998), pp. 417-420
[21.]
E.R. McRorie, P. McLoughlin, T. Russell, I. Beggs, G. Nuki, N.P. Hurst.
Cervical spine surgery in patients with rheumatoid arthritis: an appraisal.
Ann Rheum Dis., 55 (1996), pp. 99-104
[22.]
W.C. Peppelman, D.C. Kraus, W.F. Donaldson, A. Agarwal.
Cervical spine surgery in rheumatoid arthritis: improvement of neurologic deficit after cervical spine fusion.
Spine., 18 (1993), pp. 2375-2379
[23.]
J.C.M. Oostveen, A.F.J. van de Laar, J.A.G. Geelen, R. Graaff.
Successful conservative treatment of rheumatoid subaxial subluxation resulting in improvement of myelopathy, reduction of subluxation, and stabilisation of the cervical spine. A report of 2 cases.
Ann Rheum Dis., 58 (1999), pp. 126-129
[24.]
C. Rosa, M. Alves, M.V. Queirós, F. Morgado, A. Mendoza.
Neurologic involvement in patients with rheumatoid arthritis with atlantoaxial subluxation – a clinical and neurophysiological study.
J Rheumatol., 20 (1993), pp. 48-52
Copyright © 2007. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
Download PDF
Idiomas
Reumatología Clínica (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?