Sonographic investigation of the temporomandibular joint in patients with juvenile idiopathic arthritis: A pilot study

Jank, Siegfried; Haase, S.; Strobl, Heinrich; Michels, H.; Häfner, R.; Missmann, Martin; Bodner, Gerd; Mur, Erich; Schroeder, D.

doi:10.1002/art.22533

Cited by 43 publications

(49 citation statements)

References 24 publications

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“…Among those patients with TMJ arthritis, 83% had bilateral acute disease, a prevalence that is higher than the 53% reported in a recent study (6). Furthermore, 69% of patients with newly diagnosed JIA were demonstrated by MRI to have chronic TMJ arthritis, which is higher than the 55% reported in a study that used US to assess chronic destructive changes (14). More than half of the patients in our cohort had both acute and chronic findings diagnosed by MRI.…”

Section: Discussioncontrasting

confidence: 71%

“…TMJ arthritis as diagnosed by MRI was present in the majority of patients with newonset JIA. Seventy-five percent of our subjects had acute TMJ arthritis at the time of diagnosis of JIA, which is at the higher end of previously reported ranges of 17-87% (4,6,14). This prevalence at the time of JIA diagnosis indicates that the TMJ is one of the most commonly involved joints in children with JIA.…”

Section: Discussionmentioning

confidence: 42%

“…Consequently, the diagnosis of TMJ arthritis has increasingly been based on evidence obtained by imaging. Ultrasound (US), MRI, and orthopantomogram have all been used in the evaluation and diagnosis of both active TMJ arthritis and chronic TMJ arthritis (11)(12)(13)(14).…”

mentioning

confidence: 99%

“…A prospective study of 48 patients with JIA showed that 55% had destructive changes that were detected by US; effusions and pannus formation were not evaluated (14). Another group of investigators used US alone to assess TMJ involvement at the time of diagnosis of JIA and found that 65% of patients with JIA had effusions (16).…”

mentioning

confidence: 99%

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High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound

Weiss¹,

Arabshahi²,

Johnson³

et al. 2008

Arthritis & Rheumatism

239

250

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Objective. To determine the prevalence of temporomandibular joint (TMJ) disease in a cohort of children with new-onset juvenile idiopathic arthritis (JIA), and to compare magnetic resonance imaging (MRI) with ultrasound (US) for the detection of acute and chronic changes of TMJ arthritis.Methods. Between January 2005 and April 2007, children with newly diagnosed JIA were prospectively evaluated for TMJ arthritis. Prior to imaging, jaw pain and disability were assessed with questionnaires and physical examination. The TMJs of all patients were imaged with MRI and US within 8 weeks of diagnosis.Results. Of the 32 patients enrolled, 78% were female, and the median age was 8.6 years (range 1.5-17.2 years). Acute TMJ arthritis was diagnosed in 75% of the children by MRI and in none by US; chronic arthritis was diagnosed in 69% by MRI and in 28% by US. Findings of both acute and chronic TMJ disease were detected by MRI in 53% of the patients. Of those with acute TMJ arthritis, 71% were asymptomatic, and 63% had normal findings on jaw examination. Fifty-six percent of patients with acute disease had an improved maximal incisal opening after corticosteroid injection. Among these responders, 56% had been asymptomatic and had normal jaw examination findings.Conclusion. TMJ arthritis was present in the majority of patients with new-onset JIA. Findings on MRI along with responses to treatment among asymptomatic patients with normal jaw examination findings suggest that a history review and physical examination are not sufficient to screen for TMJ disease. Our results also suggest that MRI and US findings are not well correlated, and that MRI is preferable for the detection of TMJ disease in new-onset JIA.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 42%

mentioning

confidence: 99%

mentioning

confidence: 99%

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High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound

Weiss¹,

Arabshahi²,

Johnson³

et al. 2008

Arthritis & Rheumatism

239

250

View full text Add to dashboard Cite

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“…Clinical findings must, therefore, be confirmed with imaging studies. MRI is regarded as the gold standard for imaging assessment of the TMJ, but its limited availability and high cost make it unsuitable as a screening or follow-up method [6]. The orthopanogram reveals only late-stage TMJ damage, while computed tomography is not able to visualize the articular disk.…”

Section: Discussionmentioning

confidence: 99%

Sonographic evaluation of the temporomandibular joints in juvenile idiopathic arthritis

Melchiorre

Falcini

Kaloudi

et al. 2010

Journal of Ultrasound

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KEYWORDSUltrasonography; TMJ; Oligo-articular onset; Early JIA.Abstract Introduction: Juvenile idiopathic arthritis (JIA) may cause damage to the temporomandibular joint (TMJ). In oligoarticular forms of JIA, TMJ involvement is often asymptomatic and consequently overlooked. The aim of this study was to evaluate the presence of TMJ joint effusion (JE) by ultrasonography (US) in patients with early arthritis. Materials and methods: We examined 68 children (57 girls, 11 boys, age range 9.1e16.0 years, mean age 11.0 years) recently diagnosed with JIA. None had received any specific treatment for inflammation. Symptomatic TMJ involvement was diagnosed when one or more of the following were present: 1) recurrent pain (spontaneous or on movement of the jaw); 2) crepitation; 3) feeling of stiffness or fatigue of the jaw; 4) intermittent locking. US of the TMJ was performed in static and dynamic phases with a General Electric LOGIQ7 scanner and a linear transducer (8.5 MHz) positioned along the axis of the mandibular ramus. JE was diagnosed when the joint capsule was !1.5 mm thick. Results: Forty-six out (68%) of 68 children had US evidence of TMJ effusions (bilateral in 16 [35%] cases), but only 2/46 were symptomatic. Conclusions: These data suggest that children with early stage oligoarticular JIA children are likely to have inflammation of the TMJs even in the absence of symptoms. US is a simpleto-use, noninvasive, radiation-free tool that can provide useful information in the assessment and follow-up of TMJ involvement in children and young adults with JIA.Sommario Introduzione: L'artrite Idiopatica giovanile (AIG) determina alterazioni a carico della testa condilare dell'articolazione temporomandibolare (ATM). Nell'esordio oligoarticolare (OA) l'interessamento dell'ATM viene spesso trascurato perchè può essere asintomatico. Lo scopo di questo studio è quello di valutare la presenza di versamento intrarticolare (V) dell'ATM, mediante esame ecografico (US), nelle fasi precoci di malattia. Materiale e metodi: Sono stati studiati 68 bambini (57 bambine e 11 bambini, di età compresa tra 9,1 e 16, anni, età media: 11,02 AE 4,2 mesi) con AIG ad esordio OA. I pazienti (pz) erano sintomatici quando uno dei quattro sintomi seguenti era presente: 1) dolore ricorrente (a riposo o durante il movimento di apertura della bocca); 2) presenza di scrosci articolari; 3) presenza di limitazione nell'apertura della bocca; 4) locking intermittente. US è stato eseguito su entrambe le ATM sia in fase statica che dinamica, mediante ecografo General Electric (LOGIQ7) con sonda lineare (8,5 MHz) posizionata lungo l'asse maggiore del ramo condilare. Il V era presente quando lo spessore della capsula articolare era !1,5 mm. Risultati: 46/68 (68%) hanno presentato V a carico delle ATM; in 16 (35%) il V era bilaterale. 2/46 con V erano sintomatici, mentre in 44 non erano presenti sintomi. Conclusioni: Questi dati suggeriscono che un'alta percentuale di bambini e giovani adulti con AIG ad esordio OA, nella fase iniziale della malattia, presenta u...

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Long‐term followup of temporomandibular joint involvement in juvenile idiopathic arthritis

Twilt¹,

Schulten²,

Verschure³

et al. 2008

Arthritis & Rheumatism

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Objective. Temporomandibular joint (TMJ) involvement is a frequent feature in cross-sectional prevalence studies among patients with juvenile idiopathic arthritis (JIA). In this followup study, patients were reviewed after 5 years to study the course of TMJ involvement in relation to disease characteristics. Methods. Children with JIA from a previous study on TMJ involvement were included. A rheumatologic evaluation including the 6 parameters of the JIA core set and an orthodontic evaluation including an orthopantomogram (OPT) were performed. OPTs were scored according to Rohlin's grading system (grades 0 -5).Results. The overall prevalence of patients with condylar alterations decreased from 49% to 40%. Improvement of the alterations was seen in 69% of the initially affected condyles, and consequently improvement was seen in 83% of the initially affected patients. Normalization of the alterations was seen in 67% of the improved condyles, and consequently in 44% of the patients. This proves that the condyle has a regenerative capacity. Improvement was related to low disease activity and a less extensive therapeutic regimen. Conclusion. In patients with JIA, condylar alterations can improve and even regenerate. Condylar improvement is associated with a low disease activity.

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Sonographic investigation of the temporomandibular joint in patients with juvenile idiopathic arthritis: A pilot study

Cited by 43 publications

References 24 publications

High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound

High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound

Sonographic evaluation of the temporomandibular joints in juvenile idiopathic arthritis

Long‐term followup of temporomandibular joint involvement in juvenile idiopathic arthritis

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