Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:<i>A case control study</i>

Kjellberg, Heidrun; Pavlou, Ioanna

doi:10.2319/060310-302.1

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…In adult population, cervical spine involvement is seen in 35–65% of patients with JIA [3]. This wide range of reported cervical spine involvement in adult patients with juvenile-onset idiopathic arthritis could, to some extent, reflects recruitment bias since some studies were focused on clinical manifestations and others on radiographs or MRI changes [3, 9, 21, 22]. In our study, all children had LROM, 80% had neck pain, two neck stiffness and only one torticollis.…”

Section: Discussionmentioning

confidence: 99%

“…At least in the initial stage cervical spine radiography is not a routine imaging in children, but it can be useful in children with malalignment and persistent changes seen on MR to obtain functional information of cervical spine. The most frequently noted abnormalities seen on cervical radiography are apophyseal joint ankyloses or fusion at C2-C3, followed by aAAS, subaxial subluxation at levels between second and seventh cervical vertebrae, and erosions of the dens resulting in an “apple core” deformity [9]. Atlantoaxial impaction (AAI) is another serious complication of longstanding rheumatoid arthritis, rarely seen in childhood.…”

Section: Discussionmentioning

confidence: 99%

“…Radiography has been most evaluated imaging modality for assessment of cervical spine lesions and is particularly useful for evaluation of malalignment, functional impairment, morphological changes of bones, and vertebral body growth disturbances [3, 7–9]. In general, MRI is the method of choice in evaluation of cervical spine arthritis and is most useful in detecting synovitis with hypertrophic, enhanced synovia and pannus formation, joint effusion, erosions, bone marrow edema and possible neural structure compressions [10, 11].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

et al. 2017

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BackgroundsThe purpose of the study was to evaluate the clinical and magnetic resonance imaging (MRI) outcome of cervical spine arthritis in children with juvenile idiopathic arthritis (JIA), who received anti-TNFα early in the course of cervical spine arthritis.MethodsMedical charts and imaging of JIA patients with cervical spine involvement were reviewed in this retrospective study. Data, including age at disease onset, JIA type, disease activity, treatment and clinical outcome were collected. Initial and followup MRI examinations of cervical spine were performed according to the hospital protocol to evaluate the presence of inflammation and potential chronic/late changes.ResultsFifteen JIA patients with MRI proved cervical spine inflammation (11 girls, 4 boys, median age 6.3y) were included in the study: 9 had polyarthritis, 3 extended oligoarthritis, 2 persistent oligoarthritis and 1 juvenile psoriatic arthritis. All children were initially treated with high-dose steroids and methotrexate. In addition, 11 patients were treated with anti-TNFα drug within 3 months, and 3 patients within 7 months of cervical spine involvement confirmed by MRI. Mean observation time was 2.9y, mean duration of anti-TNFα treatment was 2.2y. Last MRI showed no active inflammation in 12/15 children, allowing to stop biological treatment in 3 patients, and in 3/15 significant reduction of inflammation. Mild chronic changes were found on MRI in 3 children.ConclusionsEarly treatment with anti-TNFα drugs resulted in significantly reduced inflammation or complete remission of cervical spine arthritis proved by MRI, and prevented the development of serious chronic/late changes. Repeated MRI examinations are suggested in the follow-up of JIA patients with cervical spine arthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

et al. 2017

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“…An MRI should be performed initially to avoid missing important findings and hence delaying treatment. However, Kjellberg et al demonstrated that lateral cephalometric radiographs can detect early changes and should be performed when applicable [3]. Children with cervical spine involvement often require aggressive treatment with biologics [2] to prevent impairment and disability, which hampers their quality of life.…”

Section: Discussionmentioning

confidence: 99%

Early Symptomatic Cervical Spine Involvement in an Infant with Polyarticular Juvenile Idiopathic Arthritis

Roychowdhury¹,

Satarupa²,

Datta³

2014

Ann Paediatr Rheum

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A one-year old male baby was admitted with symptoms of an inability to move his neck, occasional fever and swollen wrist, elbow and ankle joints for the last 4 months. The irritable baby was not turning his head, but instead turned his entire body to look at objects around the room and cried on minimal handling (Picture A). He was born at term, appropriate for the gestational age, and achieved the age-appropriate developmental milestones until 8 months of age. Age-appropriate language and social milestones were reached. The

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“…Radiography is useful for assessing malalignment, functional impairment, growth disturbances or morphological bony changes [ 27 , 28 ]. Apophyseal joint ankylosis, anterior atlanto-axial subluxation and atlantoaxial impaction are serious complications of rheumatoid arthritis, but these are rare in children [ 29 ]. Atlanto-axial diastases may be normal in paediatric patients; therefore, dynamic radiographic views must be interpreted with caution.…”

Section: Paediatric-specific Items Per Jointmentioning

confidence: 99%

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

et al. 2020

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Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.

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Changes in the cervical spine of children with juvenile idiopathic arthritis evaluated with lateral cephalometric radiographs:A case control study

Cited by 14 publications

References 22 publications

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

Early Symptomatic Cervical Spine Involvement in an Infant with Polyarticular Juvenile Idiopathic Arthritis

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

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