This group includes seronegative diseases (negative rheumatoid factor), such as ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD-related arthritis), and undifferentiated SpA. SpA does not frequently involve the C-spine. Regardless of the disease duration, some patients may develop apophyseal joint ankylosis, which is also a risk factor for spinal myelopathy and cervical radiculopathy. In addition to the C1/C2 level, subaxial spinal involvement may include (pseudo)spondylolisthesis, spinous process erosions, and rarely, discitis. Massive erosions with complete ligamental destruction may cause posterior or vertical atlantoaxial subluxations with subsequent spinal cord myelopathy or brain stem compression, which are life-threating conditions. Moreover, bone marrow inflammation and synovitis may lead to cartilage and bone damage with subchondral cysts and erosion. As the disease progresses, pannus may lead to ligamental laxity and tears with subsequent atlanto-axial subluxation in different directions. In RA, damage is caused by synovial and bone marrow inflammation (osteitis). This condition, if untreated, may cause myelopathy with neurological deficits. In approximately 20-70% of patients, C-spine lesions develop 10-11 years after disease onset, but in some individuals they may occur early and lead to instability. The C1-C2 joint is most frequently involved. The C-spine, after the hands and wrists and the feet, is the third most commonly affected anatomical area in 86% of patients. RA is the most common type of inflammatory arthritis. The most common are autoimmune disorders from the first 2 groups of rheumatic diseases, which are connective tissue diseases (such as rheumatoid arthritis and juvenile idiopathic arthritis ) and spondyloarthritis (SpA), among which the C-spine is mainly affected by psoriatic arthritis. The cervical (C) spine is frequently involved in many inflammatory arthropathies.
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