Rheumatoid Pannus

Rheumatoid arthritis (RA) is a disease that causes inflammation and swelling in the joints and surrounding tissues. In response to the inflammation, the synovium (tissue that lines the joints) begins to thicken. This tough, malformed tissue is called pannus tissue.



RA typically affects the joints of the hands and fingers. Occasionally, it can affect the odonoid process, which is part of the connection between the skull and the upper cervical spine. Symptoms of rheumatoid pannus at the odontoid process include: 

  • Difficulty walking, which may lead to immobility
  • Mild to severe neck pain
  • Loss of bowel or bladder control
  • Difficulty moving or coordinating your arms and hands


First, you’ll meet with your doctor for a physical exam. You’ll talk about your symptoms and your doctor may order imaging tests such as an X-ray, MRI or a CT scan.

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Treatment Options

If you’re diagnosed with RA, your Aurora team, which includes neurologists and neurosurgeons, will work with you to determine the best treatment options. Treatment for RA depends on how far the disease has progressed and which joints are affected. 

RA treatment options may include:

  • Prescription medications to control your RA.
  • Surgery to remove pressure on the spinal cord or brainstem. This is usually accomplished through a minimally invasive procedure called the Expanded Endonasal Approach (EEA), in which the odonoid pannus is removed through a nasal approach.
  • Cranio-surgical fusion to stabilize the joints and help prevent future problems.

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