Which underlying condition makes patients more prone to subluxation of C1 on C2 during endotracheal intubation?

Rheumatoid arthritis is the underlying condition that significantly increases the risk of subluxation of the first cervical vertebra (C1) on the second cervical vertebra (C2) during procedures such as endotracheal intubation. In rheumatoid arthritis, the accumulation of synovial fluid and the resulting inflammation can lead to weakening of the ligaments and other supportive structures around the cervical spine. This instability, particularly at the atlantoaxial joint (where C1 and C2 articulate), makes patients more susceptible to dislocation or subluxation, especially during manipulation of the head and neck, which is necessary for intubation.

Patients with rheumatoid arthritis can also develop atlantoaxial subluxation due to alterations in the bony structures of the cervical spine and destabilization from inflammatory changes. These risk factors necessitate careful consideration of airway management in individuals established with this condition, as improper technique or excessive force can lead to serious complications, such as spinal cord injury.

Other conditions, such as osteoarthritis, gout, and pseudogout, typically do not lead to the same degree of instability in the cervical spine and do not elevate the risk of C1-C2 subluxation during intubation to the same extent as