Presentation
Neck pain with restriction of movements.
Patient Data
There is partial fusion of anterior arch of atlas with basiocciput with irregularity along articular aspects of atlanto-occipital joint and areas of subtle marrow edema.
Anterior arch of atlas appears mildly superiorly subluxated relative to dens. Dens appears mildly enlarged. No significant mass effect is seen on cervicomedullary junction in present scan.
Significant marrow edema is seen involving posterior elements of multiple visualized cervicodorsal vertebrae.
Multilevel facet joint ankylosis is also seen.
Marrow edema is seen involving bilateral distal clavicles, costovertebral / costotransverse joints at places and possibly in right scapula.
CT confirms the multilevel facet joint ankylosis.
Case Discussion
In a known case of juvenile idiopathic arthritis, above images illustrate its spinal manifestations.
The patient is under the treatment of a pediatric rheumatologist presently. He had an onset 5 years earlier with multiple joint pains( left hip and bilateral ankle pain). He received steroids, methotrexate for 1-2 years, etanercept for 1 month and tofacitinib (JAK inhibitor) for 1 year on and off with partial response.
He is RF negative, AntiCCP negative and HLAB27 by flow negative.
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