الفهرس 
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Abstract
[ 103
SUMMARY AND COHCLUSrOH
The aim of this work was to study the incidence of
atlanto axial subluxation in JRA.
This study include 30 patients suffering from JRA
diagnosed according to the American rheumatism association
and exclusion criteria for JRA.
All patients were sUbjected to full history taking,
complete clinical, neurological examination and some
laboratory investigations :
1- Haemoglobin gram t.
2- Erythrocyte sedimentation rate (ESR).
3- Latex fixation test for rheumatoid factor.
Plain X-ray was done to all patients with JRA to
detect atlantoaxial subluxation. Lateral view was done
with maximum flexion and extension to detect atlanto axial
interval which measured between the anterior surface of
the odontoid process and posterior surface of anterior
arch of atlas vertebrae.
Atlanto-axial subluxation occurs if the interval is
more than 4.5 m.m. and there may be one millimeter
difference between extension and flexion.
According to this study AAs occur in systemic and
polyarticular onset and occur in males more than females
with long duration of the disease.
[ 104 1
There were J27 patients complained of occipital pain,
11 cases were systemic and 15 cases polyarticular and one
case was pauciarticular onset.
Radiological examination revealed that 10 cases have
atlanto axial sUbluxation, 2 cases have stepladder
affection and one case has fusion of the apophyseal joints
from C3 to C6. Neurological examination of these 10 cases
revealed that there were ’limitation of movement in one
case, while torticollis in another case.
sensation were normal in 6 cases while 4 having
hypersthesia hyper-reflexia were found in 2 cases while
normal reflexes in 4 cases and 4 cases there reflexes were
diminished.
Reduction of synovitis is the corner stone of non
surgical management of cervical spine while the remaining
treatment is symptomatic.
Soft collar are used for psychologic support, pain
relief, warmth and a feeling of stability while a rigid
collares are used to limit atlanto axial motion more than
soft collar.
Intennittent
reducing atlanto
cervical traction
axial subluxation
is also used for
but not correct
[ 105 ]
mylopathy. Presence of sever pain and neurologic
manifestation are the indications of surgical management.
So we recommend to do early plain X-ray to cervical
spine in flexion and extension for all patients suffering
from JRA to detect any changes in the cervical spine.
Finally we can conclude that radiological examination
of the cervical spine of the 30 patients with JRA revealed
that:
- AASwere detected in 10 patients of systemic and poly
articular onset. They were 7 males and 3 females. All of
them were serongative and complained of pain in the
occiput.
- 2 cases showed stepp-ladder affection of the cervical
spine - Only one case showed fusion of the apophyseal
joints from C3 to C6.
- These changes may accompanied with some neurological
manifestation such as parasthesia, vertigo, limitation
of cervical movement, torticallis and abnormal tendon
reflexes. So we advice to do early radiological
examination of the cervical spine in all patients with
JRA, This will help us to detect any changes in cervical
spine and to give the ~proper management whether
physical, medical or surgical according to the severity
of the case and so we can prevent the possible
complications.