Clinical and MRI outcome of cervical spine lesions in children with juvenile idiopathic arthritis treated with anti-TNFα drugs early in disease course

Abstract

Backgrounds: The purpose of the study was to evaluate the clinical and magnetic resonance imaging (MRI) outcome of cervical spine arthritis in children with juvenile idiopathic arthritis (JIA), who received anti-TNFα early in the course of cervical spine arthritis.

Methods: Medical charts and imaging of JIA patients with cervical spine involvement were reviewed in this retrospective study. Data, including age at disease onset, JIA type, disease activity, treatment and clinical outcome were collected. Initial and followup MRI examinations of cervical spine were performed according to the hospital protocol to evaluate the presence of inflammation and potential chronic/late changes.

Results: Fifteen JIA patients with MRI proved cervical spine inflammation (11 girls, 4 boys, median age 6.3y) were included in the study: 9 had polyarthritis, 3 extended oligoarthritis, 2 persistent oligoarthritis and 1 juvenile psoriatic arthritis. All children were initially treated with high-dose steroids and methotrexate. In addition, 11 patients were treated with anti-TNFα drug within 3 months, and 3 patients within 7 months of cervical spine involvement confirmed by MRI. Mean observation time was 2.9y, mean duration of anti-TNFα treatment was 2.2y. Last MRI showed no active inflammation in 12/15 children, allowing to stop biological treatment in 3 patients, and in 3/15 significant reduction of inflammation. Mild chronic changes were found on MRI in 3 children.

Conclusions: Early treatment with anti-TNFα drugs resulted in significantly reduced inflammation or complete remission of cervical spine arthritis proved by MRI, and prevented the development of serious chronic/late changes. Repeated MRI examinations are suggested in the follow-up of JIA patients with cervical spine arthritis.

Keywords: Anti-TNFα; Cervical spine arthritis; Juvenile idiopathic arthritis; Magnetic resonance; Outcome.

Fig. 1

MRI of cervical spine (patient #5) (T1 TSE FS axial with a contrast medium): a inital MRI showed an intense contrast enhancement of the thickened synovia in pre- and paradental space (white arrows), b follow-up MRI 6 months later showed a reduction of synovial thickening and a significantly less intense enhancement (white arrows)

Fig. 2

MRI of cervical spine (patient #8)(T1 TSE FS sagittal with a contrast medium): a initial MRI (January, 2013) showed an intense contrast enhancement of a huge synovial thickening (white arrow) in predental space with a huge anterior atlanto-axial subluxation (aAAS)(black line, 13 mm) and a compression of the anterior liquor space, normal shape of the dens, b follow-up MR (January, 2014): the evaluation of the treatment with anti-TNFα showed a reduction of synovial thickening and a less intense contrast-enhancement and less significant aAAS, normal width of the anterior liquor space, but with initial morphological changes of the dens, c follow-up MRI (March, 2016): the evaluation of the treatment with anti-TNFα showed a significant reduction of synovial thickening in the predental space and aAAS, only patchy contrast enhancement, but with morphological changes of the dens and a thinned corticalis