Which radiographic findings are characteristic of thoracic and lumbar spinal involvement in rheumatoid arthritis (RA)?

Updated: Nov 01, 2018
  • Author: Michele Calleja, MD, FRCR, MRCP; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

RA changes in the apophyseal joints of the thoracic and lumbar spine are reported only infrequently. Alterations at the discovertebral junctions have also been noted. Intervertebral disk-space narrowing, irregularity of the subchondral margins of the vertebral bodies, erosion, and sclerosis can be evident on radiography. Patients with RA who are receiving corticosteroid medication are predisposed to ischemic necrosis of bone. Although the femoral head is the usual site for this, vertebral bodies in the thoracic and lumbar regions of the spine can be affected. On radiography, this may be seen as vertebral collapse and fragmentation. Radiolucent fracture lines, which may accumulate gas from surrounding tissues, are an important clue to the diagnosis.


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