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24-01-2018 | Juvenile idiopathic arthritis | Article

Defining the normal appearance of the temporomandibular joints by magnetic resonance imaging with contrast: a comparative study of children with and without juvenile idiopathic arthritis

Journal: Pediatric Rheumatology

Authors: Matthew L. Stoll, Saurabh Guleria, Melissa L. Mannion, Daniel W. Young, Stuart A. Royal, Randy Q. Cron, Yoginder N. Vaid

Publisher: BioMed Central

Abstract

Background

Up to 80% of children with juvenile idiopathic arthritis (JIA) develop arthritis involving their temporomandibular joint (TMJ). Recent studies have questioned the sensitivity of an abnormal MRI in the diagnosis of active arthritis.

Methods

122 children without arthritis undergoing contrast MRI of the head were prospectively consented to undergo a simultaneous contrast MRI of their TMJs. As a comparison point, the initial MRI of the TMJ of 35 newly diagnosed children with JIA were retrospectively scored. The presence and size of effusion and contrast enhancement were measured in the left TMJ in all subjects.

Results

62/122 (51%) controls compared to only 10/35 JIA (29%) patients had an effusion (p = 0.022). Contrast enhancement was present in ≥97% of both groups, although the size of the enhancement was, on average, 0.2 mm larger in controls (1.1 ± 0.24 vs 0.88 ± 0.27 mm, p <  0.001). Among JIA patients, the size of the enhancement correlated inversely with disease duration (r = − 0.475, p = 0.005). Chronic changes were present in none of the controls versus 2/35 (5.5%) of the JIA patients (p = 0.049).

Conclusion

Findings consistent with minimally active TMJ arthritis appear to be equally likely in children with JIA as compared to non-inflamed controls, while this and other studies confirm that chronic changes are specific to JIA. Thus, small amounts of effusion or contrast enhancement, in the absence of chronic changes, should be interpreted with caution.
Literature
1.
Krause ML, Crowson CS, Michet CJ, Mason T, Muskardin TW, Matteson EL. Juvenile idiopathic arthritis in Olmsted County, Minnesota, 1960-2013. Arthritis Rheum. 2016;68:247–54.CrossRef
2.
Stoll ML, Sharpe T, Beukelman T, Good J, Young D, Cron RQ. Risk factors for temporomandibular joint arthritis in children with juvenile idiopathic arthritis. J Rheumatol. 2012;39:1880–7.CrossRefPubMed
3.
Cannizzaro E, Schroeder S, Muller LM, Kellenberger CJ, Saurenmann RK. Temporomandibular joint involvement in children with juvenile idiopathic arthritis. J Rheumatol. 2011;38:510–5.CrossRefPubMed
4.
Carmody RN, Gerber GK, Luevano JM Jr, et al. Diet dominates host genotype in shaping the murine gut microbiota. Cell Host Microbe. 2015;17:72–84.CrossRefPubMed
5.
Weiss PF, Arabshahi B, Johnson A, et al. 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. Arthritis Rheum. 2008;58:1189–96.CrossRefPubMed
6.
Muller L, Kellenberger CJ, Cannizzaro E, et al. Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology (Oxford). 2009;48:680–5.CrossRef
7.
Lochbuhler N, Saurenmann RK, Muller L, Kellenberger CJ. Magnetic resonance imaging assessment of temporomandibular joint involvement and mandibular growth following corticosteroid injection in juvenile idiopathic arthritis. J Rheumatol. 2015;42:1514–22.CrossRefPubMed
8.
Tzaribachev N, Fritz J, Horger M. Spectrum Of magnetic resonance imaging appearances of juvenile temporomandibular joints (TMJ) in non-rheumatic children. Acta Radiol. 2009;50:1182–6.CrossRefPubMed
9.
von Kalle T, Winkler P, Stuber T. Contrast-enhanced MRI of normal temporomandibular joints in children--is there enhancement or not? Rheumatology (Oxford). 2013;52:363–7.CrossRef
10.
von Kalle T, Stuber T, Winkler P, Maier J, Hospach T. Early detection of temporomandibular joint arthritis in children with juvenile idiopathic arthritis - the role of contrast-enhanced MRI. Pediatr Radiol. 2015;45:402–10.CrossRefPubMed
11.
Ma GM, Amirabadi A, Inarejos E, et al. MRI thresholds for discrimination between normal and mild temporomandibular joint involvement in juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2015;13:53.CrossRefPubMedPubMedCentral
12.
Resnick CM, Vakilian PM, Breen M, et al. Quantifying temporomandibular joint synovitis in children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2016;69:1795–802.
13.
Kottke R, Saurenmann RK, Schneider MM, Muller L, Grotzer MA, Kellenberger CJ. Contrast-enhanced MRI of the temporomandibular joint: findings in children without juvenile idiopathic arthritis. Acta Radiol. 2015;56:1145–52.CrossRefPubMed
14.
Vaid YN, Dunnavant FD, Royal SA, Beukelman T, Stoll ML, Cron RQ. Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2014;66:47–54.CrossRef
15.
Lin LI. A concordance correlation coefficient to evaluate reproducibility. Biometrics. 1989;45:255–68.CrossRefPubMed
16.
Stoll ML, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis: the last frontier. Int J Clin Rheumatol. 2015;10:273–86.CrossRef
17.
Stabrun AE. Impaired mandibular growth and micrognathic development in children with juvenile rheumatoid arthritis. A longitudinal study of lateral cephalographs. Eur J Orthod. 1991;13:423–34.CrossRefPubMed
18.
Larheim TA, Hoyeraal HM, Stabrun AE, Haanaes HR. The temporomandibular joint in juvenile rheumatoid arthritis. Radiographic changes related to clinical and laboratory parameters in 100 children. Scand J Rheumatol. 1982;11:5–12.CrossRefPubMed
19.
Rieter JF, de Horatio LT, Nusman CM, et al. The many shades of enhancement: timing of post-gadolinium images strongly influences the scoring of juvenile idiopathic arthritis wrist involvement on MRI. Pediatr Radiol. 2016;46:1562–7.