# Atlantoaxial Subluxation as the Initial Presentation of Rheumatoid Arthritis: A Case Report

## TL;DR

A 68-year-old man was diagnosed with rheumatoid arthritis after presenting with neck pain and neurological symptoms, highlighting the importance of recognizing rare RA manifestations.

## Contribution

This case report emphasizes the need for primary care providers to consider rare RA presentations like atlantoaxial subluxation in elderly patients.

## Key findings

- Atlantoaxial subluxation was identified as an initial manifestation of rheumatoid arthritis in an elderly patient.
- The patient's condition improved significantly after cervical fusion surgery and rehabilitation.
- Elevated rheumatoid factor and C-reactive protein, along with imaging findings, supported the RA diagnosis.

## Abstract

Rheumatoid arthritis (RA) is known for its diverse manifestations, although atlantoaxial subluxation is a rare complication. This case report sheds light on the complexity of RA diagnosis, especially in the elderly, and emphasizes the significance of primary care in identifying atypical presentations. A 68-year-old male with a history of chronic obstructive pulmonary disease, hypertension, prior traumatic neck spinal injury, and lumbosacral stenosis presented to a rural community hospital with neck pain, bilateral numbness, and arm weakness. Initially diagnosed with degenerative cervical spondylosis, his condition later progressed to include swollen, painful wrists and metacarpophalangeal joints. Diagnostic tests revealed elevated rheumatoid factor and C-reactive protein, and hand X-ray showed bone erosions. An MRI confirmed an atlantoaxial subluxation. He was diagnosed with RA based on the American College of Rheumatology/European League Against Rheumatism 2010 criteria with a score of 7. The patient underwent cervical fusion surgery and rehabilitation, leading to significant functional improvement. This case underscores the importance of a comprehensive diagnostic approach in primary care for elderly patients presenting with non-specific symptoms. It highlights the need for heightened awareness among general practitioners of atypical RA manifestations, such as atlantoaxial subluxation. The case advocates for continued research into early detection and management strategies for such rare presentations to enhance patient outcomes in RA.