Background Juvenile idiopathic arthritis (JIA) is the most common autoimmune heterogenic diseases group of unknown etiology with7 subtypes. There are markedly high prevalence of temporomandibular joint (TMJ) involvement- 17 - 87% depending on population and examination method (1). Contrast enhanced magnetic resonance imaging (MRI) is considered the optimal method for TMJ evaluation. Beside systemic therapy intraarticular (i/a) steroid injections and night splints are used in a cases of TMJ arthritis (2).
Objectives To evaluate radiologic findings with contrast enhanced MRI in children with JIA and local terapy methods applied in a cases of TMJ arthritis.
Methods Retrospectively 65 JIA cases with TMJ involvement were included analysing Children`s university hospital and Stomatology institute patient`s data. TMJ was examined with contrast enhanced MRI from 2010.-2012. Statystical analysis was performed with MS Excel 2007, SPSS 17.0.
Results There were 65 JIA patients with age ranging 7-17 (mean age 15,8); 47(72%) girls and 18(28%) boys. The mean duration of the disease from the time of diagnosis till performing MRI for TMJ was 1,5 years (range 6 weeks-10 years). There were the following JIA types: seronegative polyarthritis 45(62%), seropositive polyarthritis 6%, olygoarthritis 12%, arthritis with entesitis 8%, undiferentiated 9% and 1,5% systemic and psoriatic arhtritis. 4 groups were separated after evaluating MRI findings: 1. with signs of acute arthritis (synovial enchancement, osseous oedema, synovial fluid) were 14(21%)patients;2. with structural damage of the joint ( erosions, flattening and deformation of the mandibular head)- 7(11%); 3. signs of acute arthritis with structural changes- 27(42%); 4. without any signs of damage- 17(26%). The mean count of active joints in 1. group were -5,6; 2. -1,3; 3. -4,8; 4.- 6,4. 32 patients with TMJ arthritis were evaluated and treated by ortodontist. For 29(91%) night splints were used, 15(47%)received i/a steroid injections, 14(44%) were treated with both- night splints and i/a injections. Remaining patients were treated with one of the methods: i/a injections- 1(3%), night splints 15(47%).
Conclusions 1) Acute arthritis with structural joint damage was the most frequent finding of the MRI of TMJ in the JIA patients. 2) In cases of TMJ arthritis most often applied local therapy was night splints, less with i/a steroid injections.
Maria I. Argyropoulou, Persefoni N. Margariti, Aikaterini Karali. Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs. Eur Radiol 2009;19:693-700.
Ringold S, Torgerson TR, Egbert MA, Wallace CA. Intraarticular corticosteroid injections of the temporomandibular joint in juvenile idiopathic arthritis. J Rheumatol. 2008 Jun;35(6):1157-64
Disclosure of Interest None Declared