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Orthopaedic Surgery

Answer 3
  1. Cervical spine radiographs. The cervical spine is frequently involved in the rheumatoid patient, and ligamentous laxity and synovitis can cause progressive cervical subluxation resulting in spinal cord or brainstem involvement. In these patients, a high index of suspicion is required, and if necessary, initial studies should include plain cervical spine radiographs. This patient’s physical examination findings are consistent with upper motor neuron findings and myelopathy. Lumbar spine, hip, and pelvis radiographs may demonstrate rheumatologic involvement in these areas; however, the etiology of her myelopathy and progressive loss of function should be evaluated first. There is no role for a high-dose prednisone taper in this patient.

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