Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNF\u03b1 drugs early in disease course

Damjana Ključevšek,Nina Emeršič,Tadej Avčin,Nataša Toplak

doi:10.1186/s12969-017-0173-1

Abstract

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.

Highlights

Cervical spine arthritis is a well-recognized complication of juvenile idiopathic arthritis (JIA), usually presenting in patients with systemic or polyarticular forms of the disease [1]
Imaging modalities used in assessment of cervical spine arthritis include radiography, computer tomography and magnetic resonance imaging (MRI) [4,5,6]
Eight children were diagnosed with rheumatoid factor (RF) negative polyarthritis, 1 with RF positive polyarthritis, 3 with extended oligoarthritis, 2 with persistent Juvenile oligoarthritis (oJIA), and 1 with juvenile psoriatic arthritis

Summary

Introduction

Cervical spine arthritis is a well-recognized complication of juvenile idiopathic arthritis (JIA), usually presenting in patients with systemic or polyarticular forms of the disease [1]. Imaging modalities used in assessment of cervical spine arthritis include radiography, computer tomography and magnetic resonance imaging (MRI) [4,5,6]. 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]. The role of MRI in detecting early changes in cervical spine in JIA was first evaluated in a Turkish study showing higher sensitivity of MRI compared to radiography for detection of erosions in children [13]. A German study evaluating MR changes of cervical spine arthritis at diagnosis and response to treatment in 13 patients with JIA was published [14]. It was concluded that close MRI monitoring of these patients appears to be sensitive tool for early diagnosis and may help to detect further disease progression and complications

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