The Temporomandibular Joint in Juvenile Rheumatoid Arthritis: Radiographic Changes Related to Clinical and Laboratory Parameters in 100 Children

Abstract

A prospective study of 100 children aged 2-17 years (68 girls) with juvenile rheumatoid arthritis (JRA) was initiated to follow changes in the temporomandibular joint (TMJ), growth of the craniofacial complex and development of the dental occlusion, and to relate the findings to clinical and laboratory parameters. The mean age at onset was 5.5 years. The debut type was acute febrile in 14, pauciarticular in 64, and polyarticular in 22 patients. At examination, at mean age 9 years, 45 patients had pauci- and 55 polyarticular JRA. Definite radiographic TMJ changes were found in 41 patients (unilaterally in 17). 130 children without joint disease served as controls. Of the patients with radiographic TMJ changes, 65% had clinical symptoms and/or signs, the most frequent being restricted mouth opening. Of the patients without radiographic TMJ changes, 19% had uncertain clinical findings (pain, tenderness or slightly restricted mouth opening). Radiographic TMJ changes were significantly related to early onset of JRA, long disease duration, actual polyarticular type, high disease activity, impaired functional capacity and general health, splenomegaly and kidney involvement, low hemoglobin and high gammaglobulin concentrations. A significant relationship was also found with radiographic changes of the cervical spine. Radiographic examination seemed essential for the diagnosis of TMJ arthritis.

TMJ imaging in JIA patients—An overview

“…[12][13][14][15][16][17][18][19] Imaging modalities to assess JIA in the TMJ In early years, a number of imaging modalities have been used to assess TMJ arthritis in patients with JIA. Panoramic radiography was by far the most frequently applied method, but others include transcranial examination, 20,21 conventional tomography, 22 and a combination of panoramic, transcranial, and tomographic methods, 5,6,23 and later, computed tomography (CT) 24,25 and cone beam CT. 26,27 Ultrasound has also been investigated. 14,16,28,29 Although studies continue to be published using panoramic radiography because of its availability and simplicity, MRI has become the new standard for examining these joints because both joint inflammation and joint damage can be evaluated.…”

“…As a consequence, the TMJ has been dubbed "the forgotten joint" in pediatric rheumatology, 2 and diagnostic imaging is considered mandatory to assess JIA involvement. During the last four decades, this has been emphasized in a number of studies using conventional methods, usually panoramic radiography [3][4][5][6][7][8][9][10][11] or magnetic resonance imaging (MRI). [12][13][14][15][16][17][18][19] Imaging modalities to assess JIA in the TMJ In early years, a number of imaging modalities have been used to assess TMJ arthritis in patients with JIA.…”

Temporomandibular joint diagnostics using CBCT

“…69 It is well known that symptoms and clinical signs of TMJ involvement may be subtle, making imaging an important diagnostic tool. [75][76][77] Some CBCT studies of patients with JIA are available. A clinical evaluation according to the research diagnostic/TMD criteria 78 revealed only a few of the patients with JIA with TMJ bone abnormalities on CBCT.…”

Clinical craniofacial examination of patients with juvenile idiopathic arthritis

“…No x-ray-based imaging methods are capable of showing inflammation, but they are important in analyzing craniofacial structures and evaluating the possible destructive course of the disease to improve the selection or adaption of necessary treatment options. [25][26][27] Contrast-enhanced MRI is considered a highly sensitive method to detect TMJ inflammation, although von Kalle et al 28 recently questioned the validity of a positive MRI finding, since they found that MRI contrast enhancement is a normal finding in the soft tissue and the condyle of the TMJ in non-arthritic children …”