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The Features of Children with Juvenile Idiopathic Arthritis with Cervical Spine Involvement in the Data from a
Lubov S Sorokina1, Artem K Artamonov1, Maria A Kaneva1
1Hospital Pediatry Department, Saint Petersburg State Pediatric Medical University, Saint-Petersburg 194100, Russia.
Insights
Cervical spine arthritis (CSA) in juvenile idiopathic arthritis (JIA) is linked to longer disease duration and difficulty achieving remission. Early radiology assessment is crucial for identifying children needing advanced treatments like biologics.
Area of Science:
- Pediatric Rheumatology
- Orthopedic Surgery
- Radiology
Background:
- Cervical spine arthritis (CSA) in juvenile idiopathic arthritis (JIA) can cause irreversible functional impairment.
- Early identification and management of CSA are critical for pediatric patients.
Purpose of the Study:
- To evaluate the characteristics of JIA disease course in children diagnosed with CSA.
- To identify predictors of CSA in pediatric JIA patients.
Main Methods:
- Retrospective cohort study including 753 JIA patients (2007-2016).
- CSA diagnosis based on clinical symptoms and radiological confirmation.
- Analysis of disease duration, inflammatory activity, joint involvement, remission rates, and treatment modalities.
Main Results:
- CSA was present in 13.4% of JIA patients, particularly those with polyarticular and systemic JIA.
- CSA associated with longer disease duration, higher inflammatory activity, and increased likelihood of biologic treatment.
- Patients with temporomandibular and shoulder arthritis had a significantly higher risk of CSA.
Conclusions:
- CSA is an independent predictor of biologic treatment and failure to achieve remission in JIA.
- Identifying CSA predictors aids in early detection through functional tests and MRI.
- Radiological assessment for CSA should be considered in pediatric JIA patients when feasible.
Abstract:
Background/Objectives: Cervical spine arthritis (CSA) in children with juvenile idiopathic arthritis (JIA) can lead to clinically significant and irreversible functional impairment. Our study aimed to evaluate the features of the JIA disease course in children with CSA. Methods: In the retrospective cohort study, the data from medical charts of children with JIA (n = 753) who corresponded to the ILAR criteria and were treated from 2007 to 2016 were included. CSA was diagnosed by clinical manifestations (pain and limited range of motion) with radiological confirmation in the available cases. Results: CSA had 101 JIA patients (13.4%), predominantly with polyarticular (48%, OR = 1.8 (1.2; 2.7), p < 0.001) and systemic (18.9%, OR = 3.6 [2.0; 6.6], p < 0.001) JIA categories. CSA was associated with longer disease duration, higher inflammatory activity, a higher number of active joints, a lower probability of achieving remission (HR = 1.33 (95% CI: 1.01; 1.76, p = 0.04)), and a higher probability of being treated with biologics (HR = 1.78 (95% CI: 1.22; 2.59, p = 0.002)). Patients with temporomandibular arthritis (OR = 10.4 [5.4; 19.8], p < 0.001) and shoulder arthritis (OR = 14.1 [7.5; 26.3], p < 0.001) had the highest risk of having CSA. Conclusions: CSA was an independent predictor of treatment with biologics and failure to achieve remission. Identified predictors can help to find the group of patients with higher suspicion for whom the functional tests and MRI are required to not miss the CSA. A radiology assessment of CSA should be performed as far as possible in children, unless there are risks of general anesthesia for younger patients.
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