What is the name of the sign associated with atlantoaxial subluxation in RA?

• A. Gower sign
• B. Red sign
• C. Wink sign
• D. Bow sign

Answer: (C)

Atlantoaxial subluxation in rheumatoid arthritis arises from inflammatory damage to the ligaments at the C1–C2 joint, creating dangerous instability that can compress the spinal cord or brainstem. Clinically, certain bedside signs have historically been described to flag this cervical involvement. The Wink sign is the sign associated with atlantoaxial subluxation in RA. A positive Wink sign suggests craniovertebral instability and should prompt urgent imaging, such as dynamic cervical radiographs and MRI, to assess the degree of subluxation and guide management. This helps prevent serious neurologic complications. The other signs belong to different contexts—Gower sign is a feature of proximal muscle weakness (as in muscular dystrophy), Bow sign is related to bone deformities (e.g., rickets or tibial bowing), and Red sign is not used to indicate atlantoaxial instability—so they don’t fit this cervical RA context as well.