Clin Pain.  2024 Jun;23(1):33-38. 10.35827/cp.2024.23.1.33.

Three Diverse, Nearly Misdiagnosed Inflammatory, and Infectious Diseases at Atlantoaxial Joint

• Choi J
• Kim S
• Sung DH
• Na Y

• KMID: 2557642
• DOI: http://doi.org/10.35827/cp.2024.23.1.33

Abstract

Severe neck pain, worsened by head rotation, may signal atlantoaxial joint involvement, prompting differentiation between inflammatory and mechanical causes. This study challenges conventions by presenting three cases where inflammatory diseases, typically associated with extremities, affect the atlantoaxial joint. Cases involve a 64-year-old woman with crowned dens syndrome (CDS) due to calcium pyrophosphate crystals, a 69-year-old male with septic arthritis at the C1-2 level and an 82-year-old female with rheumatoid arthritis (RA). Despite shared severe neck pain, patients with CDS and septic arthritis show notable neck rotation limitations, while the RA patient experiences joint pain without such constraints. Diagnostic methods include cervical computed tomography (CT) for CDS, and various imaging and blood tests for septic arthritis, and American College of Rheumatology/European League Against Rheumatism criteria (ACR/EULAR) for RA. These cases highlight atypical inflammatory manifestations at the atlantoaxial joint, urging consideration in severe neck pain scenarios.

Keyword

Crowned dens syndrome; Septic arthritis; Rheumatoid arthritis