Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs

Abstract

The aim of the study was to define clinical predictors of magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Forty-six patients, aged 2.08-36.7 years, with JIA (oligoartitular 18, polyarticular 17, systemic type 11) were examined with standard plain and contrast-enhanced sequences. Of 88 TMJs examined, an abnormal condyle was observed in 32%, flattened articular eminence in 27%, flattened articular disk in 17%, intra-articular fluid in 10%, enhancing pannus in 45% and restricted condylar motion in 9%. Logistic regression analysis revealed that for abnormal condyle and flattened articular eminence, independent predictors were type of JIA (P < 0.015), age at onset (P < 0.038), and duration of disease activity (P < 0.001). Plots of the logistic regression models showed that TMJ involvement approached certainty for systemic sooner than for the other JIA types. Pannus was present with probability >0.5 when the disease started before 4 years of age. In conclusion, the systemic type of JIA, young age at onset and long duration of activity are risk factors for TMJ damage. MRI of the TMJ should be performed in patients who are less than 4 years of age at the onset of JIA, and in those with the systemic type, whatever the age of onset.

Using Clinical and Multislice Computer Tomographic Features to Assess Temporomandibular Joint Osseous Involvement in Rheumatoid Arthritis: A Preliminary Study

“…[18] For abnormal condyle and flattened articular eminence, independent predictors and risk factors for TMJ damage were a systemic type of JIA, young age at onset, and long disease duration. [31] In the present study, Sjögren's syndrome was shown in 25% of the cases. In another study, a higher frequency of TMJ and salivary gland dysfunction in RA patients was demonstrated, and disease activity (DAS28) was associated with both hyposalivation and TMJ pain and dysfunction.…”

“…[30] In another study, an abnormal condyle was observed in 32% of RA patients, flattened articular eminence in 27%, flattened articular disks in 17%, and restricted condylar motion in 9%. [31] In RA, clicking was the most frequent sign of TMJ involvement (48.8%). It was radiologically detected in 76.7% of patients, with synovial proliferation being the most frequent finding (51.1%).…”

How important is early magnetic resonance imaging of the temporomandibular joint for the treatment of children with juvenile idiopathic arthritis: a retrospective analysis

“…Interestingly, most long-term studies, including those using MRI as a diagnostic method, will find rates of TMJ pathology of around 30-45% [5,9,31,32]: Stoll et al [31] found signs of acute or chronic TMJ arthritis after a mean disease duration of 2.5 years in contrast-enhanced MRI in only 43% of 185 patients and Argyropoulou et al [32] found abnormal condyles after a mean disease duration of 7.3 years in 32% of 46 JIA patients with TMJ MRI and enhanced pannus in 45%.…”

The Difficult Diagnosis of Temporomandibular Joint Arthritis

“…In the study of Twilt, et al 4 , only 12% of patients had TMJ pain; Billiau, et al found 22% with muscle or joint tenderness 5 , and Argyropoulou, et al found 5%−8% with pain or chewing discomfort 6 . Also, clinical examination is not able to reveal early signs of active TMJ arthritis, even when performed by skilled examiners; whether they are pediatric rheumatologists or orthodontists, they will reliably find only the signs of structural damage (growth delay, asymmetric movement on mouth opening), while early inflammation is missed 7 .…”