Zusammenfassung.
Die Arthritis der Halswirbelsäule mit Instabilität im Atlantodentalgelenk und Spinalkanalstenose stellt eine typische und häufige Komplikation der Rheumatoiden Arthritis dar. Die Zervikale Myelopathie ist ein seltene aber schwerwiegende Folge dieser Manifestation. Es besteht keine strenge Korrelation zwischen dem Ausmaß der Halswirbelsäulenveränderungen und dem Auftreten einer Myelopathie. Die Diagnose der Zervikalen Myelopathie wird durch die meistens parallel bestehenden erheblichen peripheren Gelenkveränderungen mit Beeinträchtigung der Bewegungsorgane erschwert. Die Therapieentscheidung konservativ versus operativ erfordert neben subtiler klinischer, neurophysiologischer und radiologischer Diagnostik vor allem eine möglichst genaue Erfassung der Verlaufsdynamik der Rheumatoiden Arthritis und der Zervikalen Myelopathie. Voraussetzung ist eine enge Kooperation zwischen Rheumatologen, Rheumachirurgen und Neurologen.
Summary.
Arthritis of the cervical spine with instability of the atlantodental joint is a typical and frequent complicaiton in rheumatoid arthritis. Subsequent cervical myelopathy is rare but usually a severe complication. There is no stringent correlation between arthritis of cervical spine an occurrence of cervical myelopathy. Cervical myelopathy is often difficult to discern from parallel multilating peripheral joint damage, which makes the diagnosis difficult. The decision between conservative and operative therapeutic intervention has to be based on subtle clinical, neurophysiological and radiological assessment and—in particular—requires exact analysis of the course of the underlying rheumatoid arthritis and myelopathy. In this diagnostic process close collaboration of rheumatologist, surgeon and neurologist is essential.
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Arlt, A.C., Steinmetz, J. Die Zervikale Myelopathie als Komplikation der Rheumatoiden Arthritis. Z Rheumatol 63, 281–295 (2004). https://doi.org/10.1007/s00393-004-0648-6
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DOI: https://doi.org/10.1007/s00393-004-0648-6
Schlüsselwörter
- Zervikale Myelopathie
- rheumatoide Arthritis
- Epidemiologie
- Neurophysiologie
- evozierte Potenziale
- Diagnose
- Verlauf
- Therapie