“…Due to the lack of standardized measurements and techniques, imaging is not currently part of the composite measures of disease activity, which focus on clinician- and patient-reported assessments and inflammatory markers. Nevertheless, imaging is often used in clinical practice to guide decisions, especially for joints that are difficult to assess clinically (TMJ, sacroiliac joint (SIJ), cervical spine) [ 20 – 42 ].…”
Section: When Should Imaging Be Used In Juvenile Idiopathic Arthritis?mentioning
confidence: 99%
“…9 ) [ 98 , 102 – 104 ]. Recently, a consensus MRI protocol for the examination of the TMJ has been developed by Inarejos Clemente et al [ 20 ], describing the degree of normal and pathological findings using the currently available MRI scoring systems developed for JIA. Fig.…”
Section: Which Imaging Modalities Should Be Used In Juvenile Idiopath...mentioning
In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with juvenile idiopathic arthritis (JIA). Over the past few decades, great efforts have been made to improve the quality of diagnostic imaging and to reach a consensus on which methods and scoring systems to use. However, there are still some critical issues, and the diagnosis, course, and management of JIA are closely related to clinical assessment. This review discusses the main indications for conventional radiography (XR), musculoskeletal ultrasound (US), and magnetic resonance imaging (MRI), while trying to maintain a clinical perspective. The diagnostic-therapeutic timing at which one or the other method should be used, depending on the disease/patient phenotype, will be assessed, considering the main advantages and disadvantages of each imaging modality according to the currently available literature. Some brief clinical case scenarios on the most frequently and severely involved joints in JIA are also presented.
Graphical abstract
“…Due to the lack of standardized measurements and techniques, imaging is not currently part of the composite measures of disease activity, which focus on clinician- and patient-reported assessments and inflammatory markers. Nevertheless, imaging is often used in clinical practice to guide decisions, especially for joints that are difficult to assess clinically (TMJ, sacroiliac joint (SIJ), cervical spine) [ 20 – 42 ].…”
Section: When Should Imaging Be Used In Juvenile Idiopathic Arthritis?mentioning
confidence: 99%
“…9 ) [ 98 , 102 – 104 ]. Recently, a consensus MRI protocol for the examination of the TMJ has been developed by Inarejos Clemente et al [ 20 ], describing the degree of normal and pathological findings using the currently available MRI scoring systems developed for JIA. Fig.…”
Section: Which Imaging Modalities Should Be Used In Juvenile Idiopath...mentioning
In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with juvenile idiopathic arthritis (JIA). Over the past few decades, great efforts have been made to improve the quality of diagnostic imaging and to reach a consensus on which methods and scoring systems to use. However, there are still some critical issues, and the diagnosis, course, and management of JIA are closely related to clinical assessment. This review discusses the main indications for conventional radiography (XR), musculoskeletal ultrasound (US), and magnetic resonance imaging (MRI), while trying to maintain a clinical perspective. The diagnostic-therapeutic timing at which one or the other method should be used, depending on the disease/patient phenotype, will be assessed, considering the main advantages and disadvantages of each imaging modality according to the currently available literature. Some brief clinical case scenarios on the most frequently and severely involved joints in JIA are also presented.
Graphical abstract
“…Imaging these patients becomes critical in light of the frequent lack of symptoms in the presence of early or even destructive late disease. Fortunately, the development of recent guidelines and protocols [ 32 , 33 ] and resources [ 34 , 35 ] reduces the number of patients missed or undertreated. For proper screening to evaluate synovitis or early joint disease, Gadolinium contrast-enhanced MRI is ideal [ 36 , 37 ].…”
Section: Juvenile Idiopathic Arthritis Of the Temporomandibular Jointmentioning
confidence: 99%
“…It is important for the treating surgeon to communicate clearly with the radiology team to ensure proper imaging is acquired, especially in the case of children who may require sedation, or in whom an abbreviated exam is desirable. A “minimal required protocol” includes several sequences (sagittal oblique fat-suppressed T2 or STIR, sagittal oblique T1 TSE, coronal T1 TSE, and contrast-enhanced T1 FS-weighted), while a longer “ideal protocol” adds sagittal oblique fat-suppressed T1, proton density, and gradient echo sequences [ 32 ]. The use of a scoring system for joint health based on these protocols helps stage disease or monitor progression/quiescence [ 34 , 38 , 39 ].…”
Section: Juvenile Idiopathic Arthritis Of the Temporomandibular Jointmentioning
Temporomandibular disorders (TMDs) affect a high percentage of children and adults worldwide. Surgery may be indicated in severe or recalcitrant cases. Several recent advancements in TMD and temporomandibular joint (TMJ) surgery have elevated understanding and the ability to treat affected patients. We discuss recent advances in TMD epidemiology, juvenile idiopathic arthritis (JIA) of the TMJ, and surgical techniques and technologies. Technical advancements have been identified in TMJ arthroscopy, the treatment of TMJ subluxation and dislocation, and extended prosthetic total TMJ reconstruction (eTMJR). Overall, this review provides valuable insights into significant recent advancements in TMJ disorders and their surgical management.
“…Early (acute) findings include joint effusion, bone marrow edema, synovial thickening, and increased joint enhancement. Chronic dentofacial and orofacial changes are related to mandibular condyle deformity (flattening), mandibular hypoplasia, bone erosions, disk abnormalities, and subluxation [ 11 ]. It is necessary to discriminate the active TMJ arthritis and its damage and consequences, which require different management [ 7 ].…”
Our study aimed to evaluate the clinical and laboratory features of juvenile idiopathic arthritis (JIA) children with temporomandibular joint (TMJ) arthritis. In the retrospective cohort study, we analyzed data of 753 patients with JIA aged 2–17 years, depending on TMJ arthritis or not. TMJ arthritis can to be diagnosed in the presence of at least two of the following clinical signs of inflammation: pain in TMJ, jaw opening limitation, jaw opening deviation, and micrognathia. We compared clinical, laboratory, and treatment features in JIA patients depending on the involvement of TMJ. TMJ arthritis was detected in 43 (5.7%) of our patients and associated with a longer course of the disease, polyarticular JIA category, treatment with systemic corticosteroids, and longer achievement of the remission and involvement of cervical spine, hip, and shoulder. Active joints >8 (OR = 14.9, p = 0.0000001), delayed remission >7 years (OR = 3.1; p = 0.0004), delayed hip involvement (OR = 4.6; p = 0.041), hip osteoarthritis (OR = 4.0; p = 0.014), cervical spine arthritis (OR = 10.3, p = 0.000001), and corticosteroid treatment (OR = 2.3, p = 0.0007) were associated with TMJ involvement. Patients with TMJ arthritis require more biologics (OR = 3.2, p = 0.0006, HR = 2.4, p = 0.005) and have decreased probability of remission achievement (p = 0.014). Consequently, TMJ arthritis was associated with a severe disease course. Early biologic treatment and corticosteroid avoidance might decrease TMJ involvement.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
