Torticollis as the sole initial presenting sign of systemic onset juvenile rheumatoid arthritis.

We describe a 6-year-old girl with acute torticollis as the initial manifestation of systemic onset juvenile rheumatoid arthritis (JRA). She presented with isolated torticollis for 2 weeks, followed by daily intermittent fever and polyarthritis. We discuss the pathogenesis of cervical spine involvement in JRA and the clues to early diagnosis.