en Reumatology Reumatology Review Article Review Article <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:150%"><span style="font-family:Aptos,sans-serif"><span style="font-size:13.0pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times="">This study reported two cases of crowned dens syndrome (CDS) occurring in rheumatoid arthritis (RA) patients, along with a systematic literature review of similar cases, aiming to explore the association between RA and CDS within the context of calcium pyrophosphate deposition disease (CPPD disease).</span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:150%"><span style="font-family:Aptos,sans-serif"><span style="font-size:13.0pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times="">A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an online systematic literature search using the PICO (Patient, Intervention, Comparison, Outcome) strategy, to identify articles reporting the association between RA and CDS. A total of five studies were included in the systematic review. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:150%"><span style="font-family:Aptos,sans-serif"><span style="font-size:13.0pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times="">Most cases involved older adults aged between 60 and 80 years old. A marked predominance of female cases was observed in most cases. Clinical presentation typically included chronic or acute neck pain, stiffness, and headache. In all the studied cases, no neurological complications were reported. Standard radiographs identified atlanto-axial instability in two cases. CT imaging included calcifications of the transverse, alar, and apical ligaments encircling the odontoid process, as seen in most cases. CT might also reveal erosions, pseudotumors, or structural abnormalities. Management strategies combined colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, resulting in significant clinical and biological improvement. </span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:150%"><span style="font-family:Aptos,sans-serif"><span style="font-size:13.0pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times="">CDS is an uncommon condition that should be more frequently considered in patients with RA presenting with neck pain, headache, and fever. Further research studies are required to elucidate potential shared pathophysiological features between RA and CDS and to explore common treatment options.</span></span></span></span></span></span></div> Calcium pyrophosphate deposition disease, crowned dens syndrome, rheumatoid arthritis 4 0 http://caspjim.com/browse.php?a_code=A-10-3715-2&slc_lang=en&sid=1 Selma Bouden selma.bouden@gmail.com 100319475328460056316 100319475328460056316 Yes Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Emna Razgallah emnarazgallah123@gmail.com 100319475328460056317 0009-0001-8849-7677 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Rym Makhlouf rym.makhlouf.karoui@gmail.com 100319475328460056318 0009-0008-1764-1935 No Department of Radiology, Charles Nicolle Hospital, Tunis, Tunisia Leila Rouached leila.rouached@gmail.com 100319475328460056319 100319475328460056319 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Aicha Ben tekaya aichabentekaya@gmail.com 100319475328460056320 100319475328460056320 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia. Siwar Ben Dhia siwarbendhia@gmail.com 100319475328460056321 100319475328460056321 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Ines Mahmoud nefmhd@yahoo.fr 100319475328460056322 100319475328460056322 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Rawdha Tekaya tekayarawdha@yahoo.fr 100319475328460056323 100319475328460056323 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Olfa Saidane olfa_saidane@yahoo.fr 100319475328460056324 100319475328460056324 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia Leila Abdelmoula leilaabdelmoula@yahoo.fr 100319475328460056325 100319475328460056325 No Department of Rheumatology, Charles Nicolle Hospital, Tunis, Tunisia.