Spondylitis in post-pubertal patients with rheumatoid arthritis of juvenile onset.

The involvement of the cervical spine in patients with juvenile rheumatoid arthritis was mentioned by Still (1897) as among the earliest manifestations of this disease. Middlemiss (1951) has reported that clinical involvement of the cervical spine, though observed frequently, is not as often seen radiologically. Coss and Boots (1946) found fusion of two or more cervical segments in 11 per cent. of their patients with juvenile rheumatoid arthritis. In an analysis of 61 cases, Barkin (1952) and Potter, Barkin, and Stillman (1954) found clinical involvement of the cervical spine in 70 per cent. of individuals, and obtained radiological confirmation in 54 per cent. The most frequent and outstanding radiological change was narrowing, irregularity, and often fusion of the apophyseal joints of two or more cervical vertebrae. These observations have led us to review the x rays of the spine and sacro-iliac joints of our postpubertal patients with rheumatoid arthritis in whom the disease had begun in childhood. This was done to determine whether it would be possible to utilize the presence of a characteristic type of spondylitis, if found with sufficient frequency in this group, as an aid in the retrospective diagnosis ofjuvenile rheumatoid arthritis in cases in which evidence of the childhood stage of the disease might have been clinically inapparent.