Rheumatoid Arthritis Airway — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePreoperative AssessmentRheumatoid Arthritis AirwayFRCA Final

A 78-year-old woman with long-standing erosive rheumatoid arthritis is scheduled for elective posterior lumbar fusion under general anaesthesia. She reports no neck symptoms. Which associated pathology is most important to exclude because positioning for airway management and tracheal intubation could cause catastrophic neurological injury?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Atlantoaxial subluxation

Atlantoaxial subluxation is the most important consideration. Rheumatoid synovitis can cause ligamentous laxity, pannus formation and erosion around C1–C2, producing instability that may remain clinically silent. Cervical movement during positioning or laryngoscopy can alter the atlantodental relationship and risk cord or brainstem compression; the neck should therefore be assessed and airway management planned to minimise movement. Temporomandibular and cricoarytenoid joint disease are relevant because they may restrict mouth opening or cause hoarseness, stridor and airway obstruction, but they do not produce catastrophic neurological injury through cervical movement. Micrognathia is not an acquired manifestation of rheumatoid arthritis, and subglottic stenosis is not the characteristic rheumatoid cervical complication. Imaging should be selected according to clinical findings and local specialist assessment rather than described as universally mandatory.

Reference: Song J et al. Rheumatoid Arthritis in the Cervical Spine: An Updated Review of Epidemiology, Imaging, and Surgical Indications. Spine Surgery and Related Research. 2026. https://pubmed.ncbi.nlm.nih.gov/42292559/