Nationwide Children's Hospital, 700 Children's Drive A2700, Columbus, OH, 43205-2664, USA.
University Hospital Medical Center, Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Spine Deform. 2021 Nov;9(6):1705-1708. doi: 10.1007/s43390-021-00372-w. Epub 2021 Jun 16.
Case report.
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.
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.
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.
IV.
病例报告。
幼年特发性关节炎（JRA）通常以发热、皮疹、前葡萄膜炎和/或关节痛为特征。我们报告了三例因 C1-C2 旋转半脱位引起的初始斜颈作为 JRA 的初始表现。
3 名年龄 5-9 岁的女孩出现 C1-2 旋转半脱位。在所有病例中，牵引均可使寰枢关节复位。根据影像学、病史、检查和实验室结果，他们被诊断为 JRA。寰枢关节复位后，她们被转用颈圈背心和改善病情的抗风湿药物（DMARDs）。2 名年龄较大的儿童接受了 C1-2 融合术。年龄较小的儿童在初始表现 4 年后仅有轻微症状，未接受手术干预。
旋转半脱位可能是 JRA 的首发表现。较年轻的儿童可能可以通过牵引和药物治疗进行保守治疗，而年龄较大的儿童可能由于骨质破坏和颅底凹陷而需要进行枕骨到 C2 的融合术。
IV。
