A patient of rheumatoid ahritis develops sudden onset quadriparesis, Babinsky sign was positive, increased muscle tone of limbs with exaggerated tendon jerks and worsening of gait with no sensory. sphincter involvement. Best initial investigation is

Ans. a. X-ray of cervical area of neck in flexion and extension In patients of rheumatoid ahritis with compressive Myelopathy or neurological dysfunction investigation to be done next is X-ray of cervical area of neck in flexion and extension Neurological Involvement in Rheumatoid Ahritis Atlanto-axia linvolvement of cervical spine is clinically notewohy because of its potential to cause compressive Myelopathy and neurological dysfunctionQ Neurological manifestations are rarely a presenting sign or symptom of atlanto-axial disease, but they may evolve over time with progressive instability of Cl or C2Q It does not affect thoracic or lumbar spineQ Investigation: In patients of compressive Myelopathy or neurological dysfunction investigation to bedone next is X-ray of cervical area of neck in flexion and extensionQ