%0 Journal Article
%T Atlantoaxial subluxation as an early manifestation in an adolescent with undifferentiated spondyloarthritis: a case report and review of the literature
%A Eyal Muscal
%A Krishna B Satyan
%A Andrew Jea
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-275
%X We report the case of a 17-year-old Hispanic adolescent woman who was initially diagnosed with undifferentiated spondyloarthritis due to peripheral arthritis, enthesitis, a positive human leukocyte antigen B27 result, and inflammatory spinal pain lasting two months. Our patient experienced persistent and worsening occipitocervical pain and signs of myelopathy three months after diagnosis; consequently, we found atlantoaxial instability along with cervical spine bone erosion and pannus formation. She was treated surgically with a C1-2 posterior instrumented fusion and at six weeks post-operatively was started on tumor necrosis factor ¦Á blockade. Her occipitocervical symptoms subsided following surgery and initiation of immunomodulation.Our report serves to emphasize to pediatric and adult general practitioners, pediatricians, internists, family physicians, pediatric and adult rheumatologists and spine surgeons that atlantoaxial subluxation may be an early manifestation of spondyloarthritis, and that the condition is treatable by surgical intervention and immunomodulation.Studies have reported that atlantoaxial instability can be a feature of juvenile and adult ankylosing spondylitis (AS) [1-4] reactive arthritis, juvenile idiopathic arthritis [5] and rheumatoid arthritis [6] in the course of the disease. Indeed, in two separate cohorts, 7% to 21% of adult patients with ankylosing spondylitis showed signs of subluxation as early as one year following AS diagnosis. However, there have been few previous descriptions of atlantoaxial subluxation as an early manifestation of undifferentiated spondyloarthritides (SpA) in adolescents.Ankylosing spondylitis (AS), a form of adult spondyloarthritis, is a chronic rheumatic disorder characterized primarily by inflammation of the axial spine and sacroiliac joints and bone ossification. However, many individuals who also have features of peripheral arthritis and enthesitis (inflammation at tendon insertion sites) may not meet crite
%U http://www.jmedicalcasereports.com/content/5/1/275