Radiographs and MRI of the Cervical Spine in Juvenile Idiopathic Arthritis: A Cross-Sectional Retrospective Study.

Mateusz Kotecki,Piotr Gietka,Magdalena Posadzy,Iwona Sudoł-Szopińska

doi:10.3390/jcm10245798

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease among children. In some patients, cervical spine arthritis remains a serious and chronic manifestation of JIA. The aim of this study was to assess the frequency of cervical spine lesions on radiographs and MRI in JIA patients with clinical signs of cervical spine involvement and to verify if with the addition of MRI, the use of radiographs could be abandoned. Methods: This retrospective study evaluated consecutive 34 children (25 girls; aged 6–18 years, median 15.5 years) with JIA and with clinical involvement of cervical spine. In each patient, both radiographs and MRI of the cervical spine were performed. Imaging findings were correlated with clinical and laboratory data. Results: The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxations (SAS; 24%), apophyseal joint ankylosis (9%), and C1/C2 joint lesions (9%). Anterior atlanto-axial subluxation (AAS) was diagnosed only by radiography, and most of the SAS were seen on radiography, whereas only a few on MRI. Reversely, C1/C2 soft tissue involvement were seen on MRI only. Cervical spine involvement was associated with raised ESR (p = 0.012) and CRP (p = 0.014). Conclusions: The cervical spine lesions are still frequent complication of JIA affecting up to 35% of JIA patients. Most of them develop serious complications, such as AAS and ankylosis. Despite advantages of MRI in terms of the imaging of the atlanto-axial region radiography shows superiority in diagnosis of AAS and SAS.

Highlights

Juvenile idiopathic arthritis (JIA) is a systemic inflammatory disease of poorly understood complex pathogenesis, influenced by genetic and environmental factors [1]
In seven children clinically suspected of subluxation dynamic lateral radiographs were performed, while in the remaining 27 patients only radiographs in a neutral position were obtained
rheumatoid factor (RF)-negative polyarthritis was the most common form of JIA, and it was diagnosed in 13 patients; oligoarthritis was diagnosed in 10 cases, enthesitis-related arthritis (ERA) in 5, systemic-onset arthritis in 2, undifferentiated arthritis in 2, and RF-positive polyarthritis and psoriatic arthritis (PsA) were diagnosed in 1 patient each

Summary

Introduction

Juvenile idiopathic arthritis (JIA) is a systemic inflammatory disease of poorly understood complex pathogenesis, influenced by genetic and environmental factors [1]. Recent classification divides JIA into seven subtypes: systemic onset JIA, oligoarthritis, rheumatoid factor (RF) positive polyarthritis, RF-negative polyarthritis, enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), and undifferentiated arthritis (uA) [1] It is the most commonly diseased spinal location that is affected by JIA in up 77% of individuals [2]. In a recent study performed on 40 children with JIA, only 20% of patients had clinical symptoms, while in 62.5% the lesions were identified by cervical spine MRI [5]. Methods: This retrospective study evaluated consecutive 34 children (25 girls; aged 6–18 years, median 15.5 years) with JIA and with clinical involvement of cervical spine. In each patient, both radiographs and MRI of the cervical spine were performed.

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