# Cervical spine arthritis as initial manifestation in Juvenile Idiopathic Arthritis: a multicenter retrospective study

## TL;DR

This study shows that cervical spine arthritis can be the first sign of juvenile arthritis in children, often appearing as torticollis and requiring early MRI and aggressive treatment.

## Contribution

The study identifies cervical spine arthritis as a rare but significant initial manifestation of Juvenile Idiopathic Arthritis.

## Key findings

- Eight of nine patients presented with torticollis as the main symptom.
- MRI revealed synovitis in all patients and subluxation in four.
- Seven patients required biologic therapy with TNFi due to aggressive disease progression.

## Abstract

To describe the clinical characteristics, diagnostic findings, treatment, and outcomes of patients with Juvenile Idiopathic Arthritis (JIA) whose initial manifestation was cervical spine arthritis.

This retrospective multicenter study reviewed medical records of JIA patients who presented with cervical spine arthritis as the first and only symptom of the disease. Data collected included clinical presentation, imaging findings at diagnosis and follow-up, age at onset, JIA subtype, disease activity, treatment strategies, and clinical outcomes.

Nine patients were identified, five of whom were classified as having oligoarticular-persistent JIA. The mean age at symptom onset was 4.98 ± 3.08 years, with an average diagnostic delay of 6.98 ± 9.78 months. The most common presenting symptom was torticollis (88.9%), followed by limited cervical range of motion (77.8%) and neck pain (55.6%). Cervical MRI was performed in all cases, demonstrating C1–C2 synovitis in every patient and subluxation in four. Initial treatments included nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and methotrexate. Seven patients required escalation to biologic therapy with tumor necrosis factor inhibitors (TNFi), and one underwent surgical arthrodesis.

Cervical spine arthritis may be the sole initial manifestation of JIA and should be considered in children with persistent torticollis. Early MRI evaluation is critical for timely diagnosis and monitoring. The frequent need for TNFi therapy highlights the potentially aggressive nature of this presentation and the importance of early recognition and intervention.