Cervical spine RA — SCE Rheumatology MCQ
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Correct answer: B — Urgently assess cervical instability and cord compression before anaesthesia
The best answer is “Urgently assess cervical instability and cord compression before anaesthesia”. Longstanding erosive rheumatoid arthritis can cause atlantoaxial or subaxial instability, and neurological symptoms with upper-motor-neuron signs raise concern for cervical myelopathy. Neck manipulation during anaesthesia could be catastrophic. Carpal tunnel, lumbar disease and polymyalgia do not explain the combined cervical and long-tract findings.
Reference: NICE NG100 rheumatoid arthritis annual complication assessment: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations