CERVICAL SPINAL INJURY IN JUVENILE IDIOPATHIC ARTHRITIS: WHAT IS OVERLOOKED (THE FIRST-HAND EXPERIENCE AND THE BIBLIOGRAPHICAL REVIEW)
Authors:   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Raupov R.K. , Sorokina L.S. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Garipova N.T. ,   V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia, Saint Petersburg, Russia, Asadulaev M.S. ,   G.I. Turner Research Institute of Pediatric Orthopaedics, Pushkin, Pushkinsky District, Saint Petersburg, Russia, Isupova E.A. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Gaidar E.V. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Chikova I.A. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Masalova V.V. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Likhacheva T.S. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia, Mushkin A.Yu. ,   Saint Petersburg Scientific Research Institute of Phthisiopulmonology, Saint Petersburg, Russia, Kostik M.M. ,   Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia,   V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia, Saint Petersburg, Russia
Published: March 2021

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, in which involvement of the cervical spine (CS) can lead to clinically significant and irreversible functional impairment. Objective of the study: to provide a comparative characteristic of patients with JIA, depending on the presence of joint arthritis in cervical spine (CS). Materials and methods of the study: the retrospective uncontrolled continuous nonrandomized comparative study included data on patients with JIA (n=753) who were treated at the Clinic from 2007 to 2016. The diagnosis of JIA was diagnosed using ILAR criteria and all children were assessed for articular status. Disorders of the CS were diagnosed on the basis of clinical manifestations, as well as radiation studies. Results: clinical signs of CS injury were detected in 101 patients (13,4%) and were more common in patients with polyarticular (48%, OR=1,8 (1,2; 2,7), p<0,001) and systemic (18 ,9%, OR=3,6 [2,0; 6,6], p<0,001) variants of JIA. A statistically significant relationship has been found between arthritis of the CS and arthritis of the temporomandibular joints (TMJ) (OR=10,4 [5,4; 19,8], p<0,001), glenohumeral joints (OR=14,1 [7,5; 26,3], p<0,001). Patients with CS arthritis had a long disease duration and time to remission, high laboratory inflammatory activity, and the need for more frequent use of systemic glucocorticosteroids. Arthritis of the CS became an independent predictor of the need to use genetically engineered biological drugs (HR=1,78 (95% CI: 1,22; 2,59, p=0,002) and failure to achieve remission (HR=1,33 (95% CI: 1,01; 1,76 (p=0,04): Patients with arthritis of the CS had anterior chronic uveitis less often. Conclusion: all patients with JIA need functional tests to assess the state of the CS even in the absence of complaints. A radiation study of CS should be performed, as far as possible, on all children with polyarticular and systemic variants of JIA, as well as arthritis of TMJ and shoulder joint, unless there are risks of general anesthesia for younger patients.