TMJ pathomorphology in patients with JIA-radiographic parameters for early diagnosis-

Abstract

BackgroundJuvenile idiopathic arthritis (JIA) is often accompanied by pathomorphological changes to the temporomandibular joint (TMJ). By analyzing orthodontical orthopantomograms of JIA patients the aims of the study were a) classification of condyle changes, b) quantification of bony asymmetries of condylar destruction and c) detection of relationships between disease duration and TMJ-involvement.Patients/Methods46 caucasian JIA-patients (28 female; 18 male; < 16.0 years) were enrolled, each joint (n = 92) was morphologically assessed by means of orthopantomogram, quantitatively analysed and compared with duration of general disease. Condyle morphology was assessed using the Billiau scale for severity of destruction [1]. The quantitative analysis was based on ratios of condyle, ramus and mandible height.ResultsPatients were divided into groups (Group I – slightly affected, n = 36; Billiau severity 0–2; condyle findings: X-ray normal, condyle erosions, condylar flattening; Group II – severely affected, N = 10; Billiau severity 3–4; condyle findings: condylar flattenings and erosions, unilateral/bilateral complete loss of condyles), based on morphological analysis of condylar destruction. Duration of disease was significantly longer in Group II (8.9 ± 5.2 years) than in Group I (4.6 ± 4.7 years). Asymmetries of condyle, ramus and mandible height, quantitatively analysed by contralateral comparison, were significantly more marked in patients of Group II than of Group I.ConclusionsOrthopantomogram imaging can be used in orthodontics clinical routine to detect TMJ-pathologies and is an important reference for monitoring progression of JIA. Classification into severe and slightly affected TMJ is possible by analysis of condylar pathomorphology. An association between degree of destruction, extent of lower jaw asymmetry and disease duration is suggested by the results.

Clinical and Instrumental TMJ Evaluation in Children and Adolescents with Juvenile Idiopathic Arthritis: A Case—Control Study

“…Several studies have investigated TMJ involvement in JIA patients with instrumental equipment such as stereophotogrammetrically with 3D photographs [19], power Doppler ultrasound (US) [20], 3D surface scans [21], CBCT [22] and orthodontic orthopantomograms [23]. Other studies defined clinical protocols for orofacial examination in JIA children [15,24].…”

Approach to temporomandibular disorders in a patient with internal derangement type III associated with the presence of juvenile idiopathic arthritis: a case report

“…Through the combination of medical history, clinical presentation and radiological and laboratory changes, it is possible to categorize the affected individuals into seven subtypes: systemic, oligoarthritis, positive rheumatoid factor polyarthritis, negative rheumatoid factor polyarthritis, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis. [1][2][3][4] Stipulated as the most common childhood rheumatic disease, 1,3,5,6 its cause and pathogenesis are not fully understood. 3,[6][7][8] It is considered that the individual genetic susceptibility and several environmental factors can lead to an imbalance of the immune system that posteriori can result in joint and systemic manifestations.…”

“…[1][2][3][4] Stipulated as the most common childhood rheumatic disease, 1,3,5,6 its cause and pathogenesis are not fully understood. 3,[6][7][8] It is considered that the individual genetic susceptibility and several environmental factors can lead to an imbalance of the immune system that posteriori can result in joint and systemic manifestations. 3 In addition, other etiologies may be related, such as the presence of infections, physical trauma, immune disorders and stress.…”

“…11 This infiltrate and corrodes the articular cartilage and the adjacent bone, which leads to destruction of the jaw head or complete loss of it. 3,6 Thus, prolonged inflammation can lead to disturbances in joint formation and damage to osteochondral structures. 13 Unlike other joints, the mandibular growth zone is located below the surface of the head of the mandible, separated by a thin layer of fibrocartilage, playing an important role in regulating bone formation in the intramembranous and endochondral ossification of the mandible.…”

“…3,5,8,[14][15][16][17] In this context, JIA involving this joint potentially leads to degenerative arthritis changes, function restriction and pain, resulting in temporomandibular disorders (TMD). [18][19][20] Thus, all components of the TMJ can be affected, that is, the patient may present micrognathia, retrognathia, malocclusion, limited mouth opening, chewing difficulties, mandibular asymmetry, deviation, deflection, pain when perform the mandibular movements, 1,3,10,11 joint noise, crackling, 18 crackling, headache, 3 palpatory sensitivity of the TMJ or associated muscles, 6 morning stiffness, 21 flattening of the condyle, shortening of the mandibular branch, erosive changes in the articular surface and the articular disc can still be observed with perforations and dislocation in longstanding cases. 22 In view of this, this report aims to describe the conduct from the diagnosis of TMD to the proservation of the case with reduction of symptoms in an affected patient by JIA, highlighting the importance of the TMJ approach even in the absence of signs and symptoms.…”