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Pediatric Rheumatology
Published in: Pediatric Rheumatology 1/2014

Open Access 01-12-2014 | Research

Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study

Authors: Toni Hospach, Jan Maier, Peter Müller-Abt, Anita Patel, Gerd Horneff, Thekla von Kalle

Published in: Pediatric Rheumatology | Issue 1/2014

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Abstract

Background

To describe MRI and clinical findings in patients with juvenile idiopathic arthritis with cervical spine involvement at onset and follow-up under therapy.

Methods

13 patients with signs of cervical spine involvement in juvenile idiopathic arthritis with a median disease duration of 1.7 years were included in the study. Clinical records and MR images were retrospectively analyzed according to symptoms and findings concerning the cervical spine.

Results

At the onset of cervical spine involvement all patients showed limited range of motion, whereas only 5 of them complained of pain. In MR images joint hyperintensity, contrast enhancement, malalignment, ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction were found at 28, 32, 15, 2, 2 and 3 sites in 12 (93%), 13 (100%), 8 (62%), 2 (15%), 2 and 3 (20%) patients respectively. 3 of the 5 patients with pain (60%) showed ankylosis, erosions or narrowing of the spinal canal at cranio-cervical junction on MRI. At follow-up - after a median disease duration of cervical spine arthritis of 2.1 years and a variable duration of treatment with methotrexate (all patients) and biological agents (12 patients) - joint hyperintensity, enhancement and malalignment decreased to 15, 19 and 6 sites in 10 (77%), 11 (85%) and 3 (20%) patients respectively whereas ankylosis, erosion and narrowing of the spinal canal at cranio-cervical junction increased to 7, 6 and 4 sites in 3 (20%), 4 (31%) and 4 patients respectively. Pain was no longer reported, but 9 of 13 (69%) patients still had a limited range of motion with 6 of them (46%) showing skeletal changes on MRI.

Conclusions

This first MRI based follow-up study shows that cervical spine arthritis can follow a severe disease course in juvenile arthritis. While malalignments and inflammation sites decreased osseous changes with erosions, ankylosis, and narrowing of the spinal canal increased under treatment despite only minor subjective complaints. Therefore close MRI monitoring of these patients appears to be reasonable.
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Literature
1.
Neva MH, Kaarela K, Kauppi M: Prevalence of radiological changes in the cervical spine–a cross sectional study after 20 years from presentation of rheumatoid arthritis. J Rheumatol. 2000, 27 (1): 90-93.PubMed
2.
Halla JT, Hardin JG, Vitek J, Alarcon GS: Involvement of the cervical spine in rheumatoid arthritis. Arthritis Rheumatism. 1989, 32 (5): 652-659. 10.1002/anr.1780320522.CrossRefPubMed
3.
Hensinger RN, DeVito PD, Ragsdale CG: Changes in the cervical spine in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 1986, 86 (2): 189-198.
4.
Neva MH, Hakkinen A, Makinen H, Hannonen P, Kauppi M, Sokka T: High prevalence of asymptomatic cervical spine subluxation in patients with rheumatoid arthritis waiting for orthopaedic surgery. Annals Rheumatic Dis. 2006, 65 (7): 884-888.CrossRef
5.
Kolen ER, Schmidt MH: Rheumatoid arthritis of the cervical spine. Seminars Neurol. 2002, 22 (2): 179-186. 10.1055/s-2002-36541.CrossRef
6.
Lee JS, Lee S, Bang SY, Choi KS, Joo KB, Kim YB, Sung , L-Hoon I, Kim , Tae-Hwan : Prevalence and risk factors of anterior atlantoaxial subluxation in ankylosing spondylitis. J Rheumatol. 2012, 39 (12): 2321-2326. 10.3899/jrheum.120260.CrossRefPubMed
7.
Narvaez JA, Narvaez J, Serrallonga M, De Lama E, de Albert M, Mast R, Nolla JM: Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings. Rheumatology (Oxford). 2008, 47 (12): 1814-1819. 10.1093/rheumatology/ken314.CrossRef
8.
Riew KD, Hilibrand AS, Palumbo MA, Sethi N, Bohlman HH: Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am Vol. 2001, 83-A 2: 194-200.
9.
Elhai M, Wipff J, Bazeli R, Freire V, Feydy A, Drape JL, Quartier P, Kahan A, Job-Deslandre C: Radiological cervical spine involvement in young adults with polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford). 2013, 52 (2): 267-275. 10.1093/rheumatology/kes054.CrossRef
10.
Kjellberg H, Pavlou I: Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs: a case control study. Angle Orthodontist. 2011, 81 (3): 447-452. 10.2319/060310-302.1.CrossRefPubMed
11.
Laiho K, Kauppi M: The cervical spine in patients with psoriatic arthritis. Annals Rheumatic Dis. 2002, 61 (7): 650-652. 10.1136/ard.61.7.650.CrossRef
12.
Laiho K, Hannula S, Savolainen A, Kautiainen H, Kauppi M: Cervical spine in patients with juvenile chronic arthritis and amyloidosis. Clinical Exper Rheumatol. 2001, 19 (3): 345-348.
13.
Espada G, Babini JC, Maldonado-Cocco JA, Garcia-Morteo O: Radiologic review: the cervical spine in juvenile rheumatoid arthritis. Semin Arthritis Rheum. 1988, 17 (3): 185-195. 10.1016/0049-0172(88)90019-4.CrossRefPubMed
14.
Younes M, Belghali S, Kriaa S, Zrour S, Bejia I, Touzi M, Golli M, Gannouni A, Bergaoui N: Compared imaging of the rheumatoid cervical spine: prevalence study and associated factors. Joint bone Spine revue du Rhumatisme. 2009, 76 (4): 361-368. 10.1016/j.jbspin.2008.10.010.CrossRef
15.
Oren B, Oren H, Osma E, Cevik N: Juvenile rheumatoid arthritis: cervical spine involvement and MRI in early diagnosis. Turk J Pediatr. 1996, 38 (2): 189-194.PubMed
16.
Haapasaari J, Soini I, Kauppi M: MRI diagnosis and successful treatment of upper cervical spine synovitis in a patient with juvenile chronic arthritis. Clin Exp Rheumatol. 2002, 20 (2): 256-257.PubMed
17.
Hemke R, van Veenendaal M, van den Berg JM, Dolman KM, van Rossum MA, Maas M, Kuijpers TW: One-year followup study on clinical findings and changes in magnetic resonance imaging-based disease activity scores in juvenile idiopathic arthritis. J Rheumatol. 2014, 41 (1): 119-127. 10.3899/jrheum.130235.CrossRefPubMed
18.
Kauppi M: A method for classification of the posterior atlanto-axial subluxation. Clinical Rheumatol. 1994, 13 (3): 492-495. 10.1007/BF02242949.CrossRef
19.
Kauppi M, Sakaguchi M, Konttinen YT, Hamalainen M: A new method of screening for vertical atlantoaxial dislocation. J Rheumatol. 1990, 17 (2): 167-172.PubMed
20.
Van Mameren H, Drukker J, Sanches H, Beursgens J: Cervical spine motion in the sagittal plane (I) range of motion of actually performed movements, an X-ray cinematographic study. European J Morphol. 1990, 28 (1): 47-68.
21.
Guzman J, Burgos-Vargas R, Duarte-Salazar C, Gomez-Mora P: Reliability of the articular examination in children with juvenile rheumatoid arthritis: interobserver agreement and sources of disagreement. J Rheumatol. 1995, 22 (12): 2331-2336.PubMed
22.
Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P: International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, edmonton, 2001. J Rheumatol. 2004, 31 (2): 390-392.PubMed
23.
Hodgson RJ, O’Connor P, Moots R: MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology. 2008, 47 (1): 13-21. 10.1093/rheumatology/kem250.CrossRefPubMed
24.
Enden K, Laiho K, Kautiainen H, Arkela-Kautiainen M, Belt E, Kauppi M: Subaxial cervical vertebrae in patients with juvenile idiopathic arthritis–something special?. Joint Bone Spine. 2009, 76 (5): 519-523. 10.1016/j.jbspin.2008.10.009.CrossRefPubMed
25.
Fried JA, Athreya B, Gregg JR, Das M, Doughty R: The cervical spine in juvenile rheumatoid arthritis. Clinical Orthopaedics Relat Res. 1983, 179: 102-106.
26.
Sunahara N, Matsunaga S, Mori T, Ijiri K, Sakou T: Clinical course of conservatively managed rheumatoid arthritis patients with myelopathy. Spine (Phila Pa 1976). 1997, 22 (22): 2603-2607. 10.1097/00007632-199711150-00004. discussion 8CrossRef
27.
Oostveen JC, van de Laar MA: Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. Seminars Arthritis Rheumatism. 2000, 30 (1): 52-69. 10.1053/sarh.2000.8368.CrossRef
28.
Ornilla E, Ansell BM, Swannell AJ: Cervical spine involvement in patients with chronic arthritis undergoing orthopaedic surgery. Annals Rheumatic Dis. 1972, 31 (5): 364-368. 10.1136/ard.31.5.364.CrossRef
29.
Schaller J, Wedgwood RJ: Juvenile rheumatoid arthritis: a review. Pediatrics. 1972, 50 (6): 940-953.PubMed
30.
Thompson GH, Khan MA, Bilenker RM: Spontaneous atlantoaxial subluxation as a presenting manifestation of juvenile ankylosing spondylitis. A Case Report Spine. 1982, 7 (1): 78-79.PubMed
31.
Mitra S, Sharma J, Parmar VR: Atlanto-axial subluxation in JRA. Indian Pediatrics. 1999, 36 (11): 1163-1166.PubMed
32.
Breda L, Palazzi C, de Michele G, De Sanctis S, Chiarelli F: Spontaneous atlantoaxial subluxation as a presenting manifestation of juvenile ankylosing spondylitis in a female HLA-B27-negative patient. European J Pediatrics. 2005, 164 (7): 455-457. 10.1007/s00431-005-1651-x.CrossRef
33.
Muscal E, Satyan KB, Jea A: Atlantoaxial subluxation as an early manifestation in an adolescent with undifferentiated spondyloarthritis: a case report and review of the literature. J Med Case Reports. 2011, 5: 275-10.1186/1752-1947-5-275.PubMedCentralCrossRef
34.
Laiho K, Kauppi M, Konttinen YT: Why atlas, why not heracles: reflections on the rheumatoid cervical spine. Semin Arthritis Rheum. 2005, 34 (4): 637-641. 10.1016/j.semarthrit.2004.07.012.CrossRefPubMed
Metadata
Title
Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study
Authors
Toni Hospach
Jan Maier
Peter Müller-Abt
Anita Patel
Gerd Horneff
Thekla von Kalle
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Pediatric Rheumatology / Issue 1/2014
Electronic ISSN: 1546-0096
DOI
https://doi.org/10.1186/1546-0096-12-9

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