The cervical spine in juvenile rheumatoid arthritis

Clinical and roentgenographic follow-up examinations of patients with juvenile rheumatoid arthritis (JRA) suggest that neurologic complications are less likely to develop in these patients than in patients with adult rheumatoid arthritis (RA). A review of the charts of 92 patients treated for JRA during the period from 1970 to 1976 revealed that 29 (31%) had clinical evidence of cervical spine involvement. Follow-up examinations in 15 of these 29 patients revealed that all had limited cervical spine motion, 14 had neck pain and stiffness, and two had torticollis. Roentgenographic evidence of atlantoaxial subluxation was present in five patients and ankylosis of the facet joints in four. Two patients with atlantoaxial subluxation had hypereflexia and clonus, but both long tract signs and subluxation spontaneously resolved in one of these patients. None of these patients had basilar invagination or subaxial instability, which can occur in adult RA.