The Chiropractic Doctors' Association of Hong Kong


【Chiropractic Research】Craniocervical instability associated with rheumatoid arthritis

Craniocervical instability associated with rheumatoid arthritis: a case report and brief review

Eric Chun-Pu Chu1^, Arnold Yu-Lok Wong2^, Linda Yin-King Lee3^

1New York Chiropractic & Physiotherapy Centre, New York Medical Group, Hong Kong, China2Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China3School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong, China

^ORCID: Eric Chun-Pu Chu, 0000-0002-0893-556X; Arnold Yu-Lok Wong, 0000-0002-5911-5756; Linda Yin-King Lee, 0000-0002-8588-3556.

Correspondence to: Eric Chun Pu Chu, BSc, DC, FRCC. New York Chiropractic and Physiotherapy Centre, 41/F Langham Place Office Tower, 8 Argyle Street, Hong Kong, China. Email:

Abstract: Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial tissue which lines joints and tendons. The craniocervical junction is made up exclusively of synovial joints and ligaments and especially vulnerable to the inflammatory process of RA. The chronic inflammation of RA leads to loss of ligamentous restriction and erosion of the bony structures and results in craniocervical instability (CCI). This is a case report of an 80-year-old woman who had been diagnosed with seropositive RA two decades ago presented with head dropping and losing balance while walking for several months. Radiographic images of the cervical spine showed RA-related features of instability in the form of atlantoaxial instability, cranial settling and subaxial subluxation. Since physical therapy and acupuncture previously failed to provide a substantial, long-lasting outcome, the patient sought chiropractic care for her condition. The chiropractic regimen consisted of upper thoracic spine mobilization/adjustment, electrical muscle stimulation of the cervical extensors, home exercises and neck bracing. She regained substantial neck muscle strength, gaze angle and walking balance following a 4-month chiropractic treatment, although cervical kyphosis persisted. The current study aims to provide basic knowledge of CCI associated with RA and ability to modify a treatment program to accommodate the needs of patients with coexisting red flags.