Background Several studies have assessed cervical spine structural involvement in juvenile idiopathic arthritis (JIA) but most of them included only symptomatic patients without differentiating subsets of JIA.
Objectives To evaluate the frequency and severity of radiological cervical spine involvement in JIA in adulthood and understand if there are differences between subsets of JIA.
Methods We investigated 24 unselected adult patients with JIA. Age, sex, subsets of JIA according to ILAR classification, disease duration, articular destructive changes, history of clinical cervical manifestations and medical treatments were collected. Clinical evaluation included neck assessment (pain or limitation of range of motion), muscle strength of the upper and lower limbs and tendon reflexes. In all we performed the current Disease Activity Score for 28 joints (DAS 28) and Health Assessment Questionnaire (HAQ). Laboratory tests (ESR, CRP) were performed. Patients had a radiological evaluation that included cervical spine radiographs in antero-posterior, lateral views with flexion and extension and open mouth view, which were analyzed by two independent observers. In the statistical analysis (chi-Square and student T test for categorical and continuous variables, respectively), a significant association was considered if p<0.05.
Results We have evaluated 20 females and 4 males, with a mean age of 30.7±12.1 and disease duration of 20.8±12.4 years. From these, 37.5% had oligoarthritis (29.2% persistent and 8.3% extended oligoarthritis), 33.3% were RF negative polyarthritis, 16.7% RF positive polyarthritis, 8.3% psoriatic JIA and 4.2% systemic-onset JIA. Eleven patients (45.8%) reported neck pain, 7 patients (29.2%) had limited range of the cervical spine movement and 4 (16.7%) had abnormal neurological examination. Thirteen patients (54.2%) presented radiological cervical spine involvement. The most common radiographic finding was the loss of physiological lordosis present in 7 patients (29.2%). Interapophyseal joint space narrowing was found in 4 patients (16.6%). Two patients had vertical subluxation (8.3%), 2 subaxial subluxation (8.3%) and 1 anterior subluxation (4.2%). Two presented intervertebral space narrowing (8.3%) and none presented syndesmophytes, erosive lesions in odontoid process or in vertebral plates.
The loss of physiological lordosis was more associated with oligoarthritis (p=0.02). In patients with RF positive polyarthritis the intervertebral space narrowing was the most common finding, while in RF negative polyarthritis was the loss of physiological lordosis and interapophyseal joint space narrowing, though not statistically significant. The patients with psoriatic and systemic JIA had no radiographic changes.
Radiological findings were more frequent in patients with a higher number of conventional DMARDs (p=0.05) and were statistically correlated with the presence of clinical cervical manifestations (p=0.02). In contrast, were not related to sex, disease duration, ESR, CRP, number of biological agents per patient and current DAS28 and HAQ.
Conclusions Radiological cervical spine involvement was a frequent finding in our patients with JIA in adulthood, and was independent of disease duration. However, only a small number of them had severe changes. Radiologic assessment of cervical spine should be systematically performed at onset and during the course of the disease.
Disclosure of Interest None Declared
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