類風濕性關節炎合併頸椎脫位：一例報告

Rheumatoid arthritis With Atlanto－axial Dislocation: Report of Case

類風濕性關節炎一般以四肢關節症狀為主，但仍有25%以上之病患具有頸椎病變，此病例報告一位類風濕性關節炎的病人以漲尿、便秘為主訴到急診求治。經仔細檢察，最終診斷為頸椎不穩定合併神經學症狀，及時適當的處置，而免於進一步的神經學傷害。急診對於類風濕性關節炎的病人，若是周邊的關節有嚴重變形，且有頸部痛或是括約肌症狀的情形，應特別注意頸椎的問題，以避免發生病人的突發性死亡或嚴重的神經學損傷。

Rheumatoid arthritisis is a common immunologic disorder that usually involves the peripheral joints of limbs. Twenty-five perecent of patients with this disease also suffer from cervical spine involvement. We report one case of rheumatoid arthritis that initially manifested with sphincter dysfunctions, which later proved to be secondary to atlantoaxial instability with neurologic deficit. With adequate management, further neurological deficit was avoided. In rheumatoid arthritis with severe peripheral joint deformities, cervical spine involvement should be considered, especially when neck pain and sphincter dysfunction are observed. With adequate medical management, further neurological deficit and sudden death can be prevented.