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The cervical spine in juvenile chronic arthritis
Kari Laiho1, Anneli Savolainen, Hannu Kautiainen
1Rheumatism Foundation Hospital, FIN-18120 Heinola, Finland. kari@laiho.as
Background Context:
In patients with juvenile chronic arthritis (JCA) the cervical spine is often affected, leading to pain and functional limitations.
Purpose:
To describe the frequency of the radiographic abnormalities in the cervical spine of a large series of patients with JCA, examined after skeletal maturity.
Study Design:
Consecutive patients with JCA, who had cervical spine radiographs available taken at adult age (>18 years) were included in the study from one outpatient clinic and one rheumatology ward in the Rheumatism Foundation Hospital, Heinola, Finland.
Patient Sample:
The series consisted of 159 patients fulfilling the diagnostic criteria of the European League Against Rheumatism for JCA.
Outcome Measures:
Evaluation of cervical spine radiographs for inflammatory changes.
Methods:
Inflammatory changes in the cervical spine radiographs were measured as well as the size of the fourth cervical vertebra. Patient records were studied. The statistical analysis was calculated by Student's t-test or Mann-Whitney U test.
Results:
In 98 cases (62%) some inflammatory changes were detected in the cervical spine. Apophyseal joint ankylosis was noted in 65 patients (41%), anterior atlantoaxial subluxation in 27 (17 %) and atlantoaxial impaction in 39 (25 %). The fourth cervical vertebra was abnormally small in 41 patients (26%).
Conclusions:
Radiographically, the most frequent inflammatory change in the cervical spine of patients with JCA was apophyseal joint ankylosis at multiple levels. Atlantoaxial impaction and anterior atlantoaxial subluxation were typical of the upper cervical spine. Clinically, these changes tend to limit neck movements. A small C4 vertebral body was seen in patients with early disease onset and short body stature.