{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:31:41Z","timestamp":1792690301007,"version":"4.5.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the clinical characteristics, diagnostic findings, treatment, and outcomes of patients with Juvenile Idiopathic Arthritis (JIA) whose initial manifestation was cervical spine arthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective multicenter study reviewed medical records of JIA patients who presented with cervical spine arthritis as the first and only symptom of the disease. Data collected included clinical presentation, imaging findings at diagnosis and follow-up, age at onset, JIA subtype, disease activity, treatment strategies, and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine patients were identified, five of whom were classified as having oligoarticular-persistent JIA. The mean age at symptom onset was 4.98\u2009\u00b1\u20093.08 years, with an average diagnostic delay of 6.98\u2009\u00b1\u20099.78 months. The most common presenting symptom was torticollis (88.9%), followed by limited cervical range of motion (77.8%) and neck pain (55.6%). Cervical MRI was performed in all cases, demonstrating C1\u2013C2 synovitis in every patient and subluxation in four. Initial treatments included nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and methotrexate. Seven patients required escalation to biologic therapy with tumor necrosis factor inhibitors (TNFi), and one underwent surgical arthrodesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cervical spine arthritis may be the sole initial manifestation of JIA and should be considered in children with persistent torticollis. Early MRI evaluation is critical for timely diagnosis and monitoring. The frequent need for TNFi therapy highlights the potentially aggressive nature of this presentation and the importance of early recognition and intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12969-025-01161-9","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T11:52:00Z","timestamp":1762775520000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cervical spine arthritis as initial manifestation in Juvenile Idiopathic Arthritis: a multicenter retrospective study"],"prefix":"10.1186","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6033-1176","authenticated-orcid":false,"given":"Estefania","family":"Quesada-Masachs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0438-0245","authenticated-orcid":false,"given":"Jaime","family":"de Inocencio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5971-4185","authenticated-orcid":false,"given":"Juan Carlos","family":"Nieto Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Indalecio","family":"Monteagudo S\u00e1ez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3309-0722","authenticated-orcid":false,"given":"Sara","family":"Murias Loza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-4995","authenticated-orcid":false,"given":"Marta","family":"Medrano San Ildefonso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8348-739X","authenticated-orcid":false,"given":"Joan","family":"Calzada Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5184-667X","authenticated-orcid":false,"given":"Inmaculada","family":"Calvo Penad\u00e9s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0595-2153","authenticated-orcid":false,"given":"Roc\u00edo","family":"Galindo Zabala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1166-1456","authenticated-orcid":false,"given":"Mireia","family":"Lopez Corbeto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8792-4219","authenticated-orcid":false,"given":"Jordi","family":"Ant\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"issue":"Suppl 10","key":"1161_CR1","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/acr.24192","volume":"72","author":"C Trincianti","year":"2020","unstructured":"Trincianti C, Consolaro A. 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Informed consent was obtained from all participants\/legal guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of anonymized clinical data and imaging was obtained from the legal guardians of all patients included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Estefania Quesada-Masachs is a pediatric rheumatologist and currently serves as a Research Assistant Professor at the University of Miami Miller School of Medicine. Her areas of expertise include type 1 diabetes, in-situ protein expression in human tissue, musculoskeletal imaging, juvenile idiopathic arthritis and early-onset autoimmune diseases.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Author information (optional)"}},{"value":"This work did not receive specific funding. EQM received support from a grant of the Spanish Society of Rheumatology (\n                      Sociedad Espa\u00f1ola de Reumatolog\u00eda\n                      ). MLC received support from a grant of the\n                      Instituto Carlos III (R\u00edo Ortega\n                      CM18\/00012). This research was also supported by the Diabetes Research Initiative Foundation at the University of Miami. The authors acknowledge the critical support and resources provided by these institutions, which have significantly contributed to the advancement of this work. The content is solely the responsibility of the authors and does not necessarily represent the official views of the University of Miami or the Diabetes Research Institute Foundation.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"The source(s) of support in the form of grants or industrial support"}},{"value":"This study received ethics approval from the Clinical Research Ethics Committee of Vall d\u2019Hebron University Hospital and Research Institute (Comit\u00e8 \u00c8tic d\u2019Investigaci\u00f3 Cl\u00ednica \u2013 CEIC \u2013 de l\u2019Hospital Universitari Vall d\u2019Hebron \u2013 Institut de Recerca Vall d\u2019Hebron). Code number PR(AG)1852015.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statement of ethics and consent"}},{"value":"The authors declare no competing interests.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"111"}}