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elbows. Over time, the arthritis tends to resolve, although in some patients, it may
persist and affect additional joints. The polyarticular subtype affects older girls,
involves 5 or more joints at onset, and mimics adult RA. Patients with the systemic-
onset subtype have not only arthritis but fever, skin rashes, blood cell abnormalities,
and liver in
ammation. Treatment of juvenile idiopathic arthritis generally follows
that of adult RA.
Cervical spine in
fl
ammation occurs in up to 70 % of patients with juvenile
idiopathic arthritis, and affects patients with each subtype. Neck pain and limited
range of motion are the most common associated symptoms. While atlanto-axial
subluxation and subaxial subluxation occur, the most common cervical spine
abnormality in juvenile idiopathic arthritis is fusion of the facet joints [
76
]. This
fusion often extends for the entire length of the cervical spine, with consequent
inability to freely move the head and neck.
Radiographs are useful to detect cervical spine involvement, and MRI may be
helpful to identify areas of potential neurological impingement.
fl
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