13.1 Diagnosis of mandibular condyle abnormalities in children with juvenile idiopathic arthritis

The temporomandibular joint (TMJ) is commonly found to be affected in patients with juvenile idiopathic arthritis. Among the currently available TMJ imaging techniques, corrected sagittal tomography (CST) provides the most accurate information for the osseous components of the TMJ. Panoramic radiography (PR), though not as accurate a technique, still has its place in the diagnostic process, as a screening method.

Aim—The evaluation of PR as a diagnostic means in cases of condylar abnormalities, in comparison with CST.

Subjects and methods—30 juveniles attending the Orthodontic Department of the University of Athens, 15 of whom were patients with juvenile idiopathic arthritis of the polyarthritic type. All radiographs of the same type were taken by the same operator, using the same machine. CSTs and PRs were examined separately and in random order, by two examiners. The method error was assessed, re-examining 10 radiographs of each group. Condyles were evaluated for the gross presence or absence of flattening, erosion, osteophytes, subchondral sclerosis, and also their symmetry as regards their counterpart.

Results and conclusions—The intra- and interexaminer agreement for both techniques was found to be higher than 90% and 85% respectively. For the detection of erosion, flattening, and sclerosis of the condyles, the results between the two techniques were not found to be different at a statistically significant level. No conclusions could be made for osteophytes as only a few were seen. The observed disagreement, at the level of p<0.1, for the asymmetry between right and left condyles of the same patient, was attributed to the inability of the PR to guarantee an individualised view for every TMJ.

The PR was found to be a satisfactory method for an initial gross evaluation of the condylar condition and therefore should be carefully assessed in every case.

13.2 Is range of movement a measurable component of function in children with active juvenile idiopathic arthritis?

Introduction—Many indicators of disease activity are …