The late atlantoaxial subluxation in a patient with juvenile idiopathic arthritis

Introduction Atlantoaxial instability has been described as a manifestation of ankylosing spondylitis (juvenile and adult onset), reactive arthritis, juvenile idiopathic arthritis, and rheumatoid arthritis; however, it has rarely been reported as an early manifestation of these disorders (1). Instability of the atlantoaxial joint may lead to impingement on the cord and brainstem. There may also be cephalad encroachment of the odontoid into the foramen magnum. Locke and colleagues studied the atlanto-odontoid distance in 200 normal children aged 3 to 15 years, but the age and sex were not significant factors (2-4).