Is cervical spine involvement in juvenile polyarthritis under-recognized?

摘要

Elhai ef a/.'s [1] study evaluates the frequency of radiological cervical spine involvement in young adults with polyarticular JIA (pJIA) compared with RA patients. The authors show that about two-thirds of patients in both groups had radiographic abnormalities in the cervical spine, including anterior atlantoaxial subluxation, erosion of the odontoid process, C1-C2 arthritis and apophyseal joint arthritis. Lesions were found even in patients without clinical symptoms and their presence correlated positively with the severity of disease. The similar prevalence of structural cervical spine lesions in young adults with pJIA and RA highlights the importance of this complication for the long-term follow-up of juvenile polyarthritis. This aspect of pJIA outcome needs further study because literature on the topic is relatively scarce, in contrast to the abundant number of papers on cervical problems in RA. Another striking point of this study is the high percentage of asymptomatic patients presenting with radiological cervical lesions. Only 42% of patients without neck complaints or findings on examination had a normal cervical scan; accordingly, the authors raise the question of the frequency of systematic cervical spine radiological controls during follow-up in pJIA.