RA Cervical Myelopathy Signs — SCE Rheumatology MCQ

Correct answer: C — Progressive hand clumsiness and gait unsteadiness with brisk leg reflexes, ankle clonus, extensor plantar responses and urinary urgency

The correct answer is C. Progressive gait disturbance and hand dysfunction accompanied by pyramidal signs below the cervical lesion—hyperreflexia, clonus and extensor plantar responses—indicate spinal cord dysfunction. Urinary urgency or other sphincter disturbance suggests more advanced myelopathy. In rheumatoid arthritis, atlanto-axial or other cervical instability can compress the cord and warrants urgent cervical MRI and spinal surgical assessment. Option D is typical of median neuropathy at the carpal tunnel, which is common in RA but does not produce leg signs. Option A suggests local cervical joint disease without cord involvement. Diplopia and vertigo in D may indicate vertebrobasilar or brainstem involvement but, without long-tract features, do not establish myelopathy. Occipital pain in E may reflect C2-root irritation and can accompany atlanto-axial disease, but a normal neurological examination provides no evidence of cord dysfunction.

Reference: Davies BM et al. Degenerative cervical myelopathy, clinical features section. BMJ. 2018;360:k186. https://pubmed.ncbi.nlm.nih.gov/7330168/