Pathogenesis of diskovertebral lesions in rheumatoid arthritis: A fresh look at an old and heated controversy

The origin of diskovertebral joint (DVJ) destruction in rheumatoid arthritis remains controversial. Two mechanisms have been emphasized: extension of the inflammatory process to the DVJ from the apophyseal joint (or the neurocentral joint) and apophyseal joint instability leading to chronic DVJ trauma. The authors compared the alterations seen in the cervical and lumbar DVJ as well as the manubriosternal joint derived from a rheumatoid cadaver. The radiographic pathologic correlation supported the importance of spinal instability and injury in the pathogenesis of the DVJ lesion, even if synovial inflammation about the neurocentral joint was evident. The manubriosternal abnormalities, however, were related to synovial inflammation alone