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

Abstract

To evaluate whether plain lateral cephalometric radiographs in the neutral position could be used as a diagnostic tool to investigate changes in the cervical spine related to juvenile idiopathic arthritis (JIA). Lateral cephalometric radiographs of 82 subjects, 21 males and 61 females (8-25 years old), affected with JIA were revised and compared with 82 healthy control subjects matched in age and gender. Changes inspected in the cervical spine were erosions of the dens and fusion of the apophyseal joints. Anterior atlantoaxial subluxation of the first vertebra in relation to the second was examined by measuring the anterior atlanto-dens interval (aADI). Atlantoaxial impaction (AAI) was studied by using the Sakaguchi-Kauppi method. In the JIA sample, erosion was seen in 14.7%, (12 patients), of the patients and apophyseal joint ankylosis (fusion) in 18.3%, (15 patients). Three children and one adult had aADI more than 4.5 or 3 mm, respectively, which is considered to be abnormally increased, and AAI was noted in 13.0% of the subjects. In total, 35%, (29 children), of the children with JIA showed one or several radiographically visible changes as described earlier. Two of the control subjects showed ankylosis of the apophyseal joints, and one had aADI of 4 mm. Compared with the controls, significantly more changes were found in the JIA group. It can be concluded that arthritic changes in the cervical spine can be detected at a young age on plain lateral cephalometric radiographs and should be evaluated when available.