Cervical Spine Involvement in Patients with Juvenile Idiopathic Arthritis: Radiographic and MRI Findings

Presentation Format: Scientific poster presentation.

Purpose or Learning Objective: Juvenile idiopathic arthritis (JIA) is the most common inflammatory arthritis in children. Rarely, JIA affects the cervical spine, which may be subclinical. The goal of this study was a retrospective analysis of cervical spine involvement in children with JIA.

Methods or Background: A total of 34 children (25 girls, age range: 6–18 years; median age: 15.5 years) diagnosed with JIA and clinical symptoms suggesting cervical spine involvement were enrolled in the study. Every patient had both radiography and magnetic resonance imaging (MRI) performed.

The imaging findings were correlated with clinical (age, sex, disease duration, concomitant peripheral joint arthritis, and current treatment) and laboratory (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) data.

Results or Findings: The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxation (SAS; 24%), apophyseal joint ankylosis (9%), and C1–C2 joint lesions (9%) including anterior atlantoaxial subluxation (AAS). Dynamic radiographs revealed all eight cases (24%) of SAS-like lesions and two cases (6%) of anterior AAS. MRIs confirmed only two cases of SAS-like lesions and none of the cases with AAS. Both techniques diagnosed three cases of apophyseal joint ankylosis (9%), two cases of vertical AAS (6%), and one case of congenital growth disturbances. MRIs revealed active or chronic lesions at the C1–C2 level (e.g., effusions, synovitis, and bone marrow edema) in 9% of patients.

Cervical spine involvement was significantly linked to elevated ESR (p = 0.012) and CRP (p = 0.014). No association was found between diagnosed lesions of the cervical spine and disease duration, age at diagnosis, treatment, or concomitant peripheral joint arthritis.

Conclusion: Cervical spine involvement is still an issue and may be affected in up to 35% patients with JIA. The most serious complications of cervical involvement include atlantoaxial subluxation and ankylosis, seen in 25% of patients with imaging changes. In children there is no strict correlation between imaging lesions and neurologic manifestation. This underlines the clinical importance of early radiographic diagnosis of JIA's impact on the cervical spine.