Cervical spine in patients with juvenile chronic arthritis and amyloidosis

To describe cervical spine abnormalities in a group of adult patients with refractory juvenile chronic arthritis (JCA) complicated by secondary amyloidosis (SA).

The series consists of 49 patients who fulfilled the diagnostic criteria of the European League Against Rheumatism for JCA, here complicated by secondary amyloidosis (SA). We evaluated their clinical records and most recent cervical spine radiographs taken in adult age (> 18 years) at or after the diagnosis of SA.

Forty-two (86%) patients evinced inflammatory changes in the cervical spine. Apophyseal joint ankylosis was seen in 31 (63%) and atlantoaxial impaction (AAI) in 28 (57%) patients; anterior atlantoaxial subluxation (aAAS) was noted in 17 (35%) patients, and 19 (39%) had the combination of AAI and apophyseal joint ankylosis. The size of the 4th vertebral body was small or narrow in 14 (29%) patients with JCA onset at a median of 3 years of age (range 1-12).

Inflammatory cervical spine disorders are common and may be detected along the entire length of the cervical spine in patients with severe refractory JCA. The disorders tend to ankylose the apophyseal joints and destroy the atlantoaxial joints, resulting in aAAS or impaction. These changes will restrict rotatory and bending movements in the cervical spine. A peculiarly small or narrow cervical vertebral body was seen mainly in patients with early onset disease. The present findings shed light on the characteristics and course of the inflammatory changes in the cervical spine in patients with refractory JCA.