The cervical spine in juvenile idiopathic arthritis

The objective of this research is to describe the clinical and radiological aspects of cervical spine involvement in Juvenile Idiopathic Arthritis (JIA). Patients fulfilled the ILAR (International League Against Rheumatism) criteria for the diagnosis of the JIA. The diagnosis of JIA course types were used in this study.  In all patients conventional X-rays of the cervical spine were obtained and the relationship between clinical status (neck pain, limitation of neck motion and neurological complications) and radiographs findings were studied. Cervical spine disease was assessed according clinical parameters related to JIA. 120 patients were included, mean age 22 years ± 10 [5-49], disease duration of JIA was 12 years ± 9.6 [2-35]. Thirty cases of neck pain were found, 18 patients had an inflammatory cervical pain. Neurological complications (tetraparesia in one case and one case of pyramidal irritation) were noted. In our series no cervical spine surgery was performed. In 27 cases (22.5 %), radiological inflammatory abnormalities were detected in the cervical spine: Apophyseal joint ankylosis was noted in 14 patients, anterior atlantoaxial subluxation in 6 and cervical syndesmophytosis in 5 cases. Cervical spine involvement was more frequent in polyarticular and spondylarthropathy subtypes (p=0.01). Cervical spine changes were common in patients with long lasting (p < 0.001) and severe JIA (p= 0.04). In our series, the most frequent inflammatory change was apophyseal joint ankylosis and anterior atlantoaxial subluxation. Cervical spine changes are common in patients with long lasting JIA.