A T Whitaker1, M P Glotzbecker2. 1. Nationwide Children's Hospital, 700 Children's Drive A2700, Columbus, OH, 43205-2664, USA. 2. University Hospital Medical Center, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA. Michael.Glotzbecker@uhhospitals.org.
Abstract
STUDY DESIGN: Case report. INTRODUCTION: Juvenile rheumatoid arthritis (JRA) typically presents with fever, rash, anterior uveitis, and/or joint pain. We present three cases with initial torticollis due to rotatory subluxation of C1-C2 as an initial sign of JRA. CASE REPORTS: Three girls, ages 5-9, presented with C1-2 rotatory subluxation. Traction was able to reduce the atlanto-axial joint in all cases. Based on imaging, history, exam, and laboratory results, they were diagnosed with JRA. After reduction of the atlantoaxial joint, they were transitioned to a halo vest and disease-modifying antirheumatic drugs (DMARDs). The older 2 children underwent C1-2 fusion. The younger child has minimal symptoms and has not undergone surgical intervention 4 years from initial presentation. CONCLUSION: Rotatory subluxation can be the first presenting sign of JRA. Younger children may be able to be treated conservatively with traction and medication, while older children may require occiput to C2 fusion due to bony destruction and basilar invagination. LEVEL OF EVIDENCE: IV.
STUDY DESIGN: Case report. INTRODUCTION:Juvenile rheumatoid arthritis (JRA) typically presents with fever, rash, anterior uveitis, and/or joint pain. We present three cases with initial torticollis due to rotatory subluxation of C1-C2 as an initial sign of JRA. CASE REPORTS: Three girls, ages 5-9, presented with C1-2 rotatory subluxation. Traction was able to reduce the atlanto-axial joint in all cases. Based on imaging, history, exam, and laboratory results, they were diagnosed with JRA. After reduction of the atlantoaxial joint, they were transitioned to a halo vest and disease-modifying antirheumatic drugs (DMARDs). The older 2 children underwent C1-2 fusion. The younger child has minimal symptoms and has not undergone surgical intervention 4 years from initial presentation. CONCLUSION: Rotatory subluxation can be the first presenting sign of JRA. Younger children may be able to be treated conservatively with traction and medication, while older children may require occiput to C2 fusion due to bony destruction and basilar invagination. LEVEL OF EVIDENCE: IV.
Authors: Kira Endén; Kari Laiho; Hannu Kautiainen; Marja Arkela-Kautiainen; Eero Belt; Markku Kauppi Journal: Joint Bone Spine Date: 2009-02-11 Impact factor: 4.929
Authors: Alexandra D Beier; Shobhan Vachhrajani; Simon H Bayerl; Claudia Y Diaz Aguilar; Maria Lamberti-Pasculli; James M Drake Journal: J Neurosurg Pediatr Date: 2012-02 Impact factor: 2.375