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Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study

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Abstract

The aims of this longitudinal study were to perform a comprehensive clinical evaluation of temporomandibular joint (TMJ) and to investigate the association between the clinical and magnetic resonance imaging (MRI) findings in the TMJs of patients with juvenile idiopathic arthritis (JIA). Seventy-five patients with JIA participated in this study. All patients underwent a rheumatological examination performed by a paediatric rheumatologist, a TMJ examination performed by a single dentist and an MRI with contrast of the TMJs. These examinations were scheduled on the same date. The patients were examined again 1 year later. Twenty-eight (37.3 %) patients reported symptoms at the first evaluation and 11 (14.7 %) patients at the second evaluation. In relation to signs, 35 (46.7 %) of the patients presented at least one sign at the first evaluation and 29 (38.7 %) at the second. Intense contrast enhancement of TMJ was significantly associated with disease activity (p < 0.001) at the first evaluation and a trend to significance was observed at the second (p = 0.056), with poly/systemic subtypes (p = 0.028 and p = 0.049, respectively), with restricted mouth opening capacity (p = 0.013 and p = 0.001, respectively), with the presence of erosions at both evaluations (p = 0.0001 and p < 0.0001, respectively) and with altered condylar shape at the second evaluation (p = 0.0005). TMJ involvement is highly prevalent in JIA patients, with asymptomatic children presenting severe structural alterations of the TMJ. The TMJ should always be evaluated in JIA patients, even in the absence of signs and symptoms.

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References

  1. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392

    PubMed  Google Scholar 

  2. Ronning O, Valiaho ML, Laaksonen AL (1974) The involvement of the temporomandibular joint in juvenile rheumatoid arthritis. Scand J Rheumatol 3:89–96

    Article  CAS  PubMed  Google Scholar 

  3. Ronchezel MV, Hilario MO, Goldenberg J, Lederman HM, Faltin K Jr, de Azevedo MF et al (1995) Temporomandibular joint and mandibular growth alterations in patients with juvenile rheumatoid arthritis. J Rheumatol 22:1956–1961

    CAS  PubMed  Google Scholar 

  4. Mericle PM, Wilson VK, Moore TL, Hanna VE, Osborn TG, Rotskoff KS et al (1996) Effects of polyarticular and pauciarticular onset juvenile rheumatoid arthritis on facial and mandibular growth. J Rheumatol 23:159–165

    CAS  PubMed  Google Scholar 

  5. Kuseler A, Pedersen TK, Herlin T, Gelineck J (1998) Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis. J Rheumatol 25:1406–1412

    CAS  PubMed  Google Scholar 

  6. Pedersen TK, Jensen JJ, Melsen B, Herlin T (2001) Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. J Rheumatol 28:2109–2115

    CAS  PubMed  Google Scholar 

  7. Twilt M, Mobers SM, Arends LR, ten Cate R, van Suijlekom-Smit L (2004) Temporomandibular involvement in juvenile idiopathic arthritis. J Rheumatol 31:1418–1422

    PubMed  Google Scholar 

  8. Karhulahti T, Ylijoki H, Ronning O (1993) Mandibular condyle lesions related to age at onset and subtypes of juvenile rheumatoid arthritis in 15-year-old children. Scand J Dent Res 101:332–338

    CAS  PubMed  Google Scholar 

  9. Martini G, Bacciliero U, Tregnaghi A, Montesco MC, Zulian F (2001) Isolated temporomandibular synovitis as unique presentation of juvenile idiopathic arthritis. J Rheumatol 28:1689–1692

    CAS  PubMed  Google Scholar 

  10. Scolozzi P, Bosson G, Jaques B (2005) Severe isolated temporomandibular joint involvement in juvenile idiopathic arthritis. J Oral Maxillofac Surg 63:1368–1371

    Article  PubMed  Google Scholar 

  11. Larheim TA, Hoyeraal HM, Stabrun AE, Haanaes HR (1982) The temporomandibular joint in juvenile rheumatoid arthritis. Radiographic changes related to clinical and laboratory parameters in 100 children. Scand J Rheumatol 11:5–12

    Article  CAS  PubMed  Google Scholar 

  12. Kjellberg H, Fasth A, Kiliaridis S, Wenneberg B, Thilander B (1995) Craniofacial structure in children with juvenile chronic arthritis (JCA) compared with healthy children with ideal or postnormal occlusion. Am J Orthod Dentofac Orthop 107:67–78

    Article  CAS  Google Scholar 

  13. Weiss PF, Arabshahi B, Johnson A, Bilaniuk LT, Zarnow (2008) 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 58:1189–1196

    Article  PubMed  Google Scholar 

  14. Hu YS, Schneiderman ED, Harper HP (1996) The temporomandibular joint in juvenile rheumatoid arthritis: Part II. Relationship between computed tomographic and clinical findings. Pediatr Dent 18:312–319

    CAS  PubMed  Google Scholar 

  15. Svensson B, Adell R, Kopp S (2000) Temporomandibular disorders in juvenile chronic arthritis patients. A clinical study. Swed Dent J 24:83–92

    CAS  PubMed  Google Scholar 

  16. Billiau AD, Hu Y, Verdonck A, Carels C, Wouters C (2007) Temporomandibular joint arthritis in juvenile idiopathic arthritis: prevalence, clinical and radiological signs, and relation to dentofacial morphology. J Rheumatol 34:1925–1933

    PubMed  Google Scholar 

  17. Müller L, Kellenberger CJ, Cannizzaro E, Ettlin D, Schraner T, Bolt IB et al (2009) Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology (Oxford) 48:680–685

    Article  Google Scholar 

  18. Smith HJ, Larheim TA, Aspestrand F (1992) Rheumatic and nonrheumatic disease in the temporomandibular joint: gadolinium enhanced MR imaging. Radiology 185:229–234

    Article  CAS  PubMed  Google Scholar 

  19. Wallace CA, Ruperto N, Giannini E (2004) Childhood arthritis and rheumatology research alliance; Pediatric Rheumatology International Trials Organization; Pediatric Rheumatology Collaborative Study Group. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. J Rheumatol 31:2290–2294

    PubMed  Google Scholar 

  20. Sheppard IM, Sheppard SM (1965) Maximal incisal opening—a diagnostic index? J Dent Med 20:13–15

    CAS  PubMed  Google Scholar 

  21. Agerberg G (1974) Maximal mandibular movements in children. Acta Odontol Scand 32:147–159

    Article  CAS  PubMed  Google Scholar 

  22. Yale SH, Allison BD, Hauptfuehrer JD (1966) An epidemiological assessment of mandibular condyle morphology. Oral Surg Oral Med Oral Palthol 21:169–177

    Article  CAS  Google Scholar 

  23. Brooks SL, Westesson PL, Eriksson L, Hansson LG, Barsotti JB (1992) Prevalence of osseous changes in the temporomandibular joint of asymptomatic persons without internal derangement. Oral Surg Oral Med Oral Pathol 73:118–122

    Article  CAS  PubMed  Google Scholar 

  24. Goldbach-Mansky R, Woodbum J, Yao L, Lipsky PE (2003) Magnetic resonance imaging in the evaluation of bone damage in rheumatoid arthritis. A more precise image or just a more expensive one? Arthritis Rheum 48:585–589

    Article  PubMed  Google Scholar 

  25. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  26. Stabrun AE, Larheim TA, Hoyeraal HM (1989) Temporomandibular joint involvement in juvenile rheumatoid arthritis. Clinical diagnostic criteria. Scand J Rheumatol 18:197–204

    Article  CAS  PubMed  Google Scholar 

  27. Olson L, Eckerdal O, Hallonsten AL, Helkimo M, Koch G, Gare BA (1991) Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study. Swed Dent J 15:71–83

    CAS  PubMed  Google Scholar 

  28. Wenneberg B, Kjellberg H, Kiliaridis S (1995) Bite force and temporomandibular disorder in juvenile chronic arthritis. J Oral Rehabil 22:633–641

    Article  CAS  PubMed  Google Scholar 

  29. Harper RP, Brown CM, Triplett MM, Villasenor A, Gatchel RJ (2000) Masticatory function in patients with juvenile rheumatoid arthritis. Pediatr Dent 22:200–206

    CAS  PubMed  Google Scholar 

  30. Stabrun AE, Larheim TA, Höyeraal HM, Rösler M (1988) Reduced mandibular dimensions and asymmetry in juvenile rheumatoid arthritis. Arthritis Rheum 31:602–611

    Article  CAS  PubMed  Google Scholar 

  31. Twilt M, Schulten AJ, Nicolaas P, Dülger A, van Suijlekom-Smit LW (2006) Facioskeletal changes in children with juvenile idiopathic arthritis. Ann Rheum Dis 65:823–825

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  32. Kuseler A, Pedersen TK, Gelineck J, Herlin T (2005) A 2 year follow-up study of enhanced magnetic resonance imaging and clinical examination of the temporomandibular joint in children with juvenile idiopathic arthritis. J Rheumatol 32:162–169

    PubMed  Google Scholar 

  33. Arabshahi B, Cron RQ (2006) Temporomandibular joint arthritis in juvenile idiopathic arthritis: the forgotten joint. Curr Opin Rheumatol 18:490–495

    Article  PubMed  Google Scholar 

  34. Pedersen TK, Kuseler A, Gelineck J, Herlin T (2008) A prospective study of magnetic resonance and radiographic imaging in relation to symptoms and clinical findings of the temporomandibular joint in children with juvenile idiopathic arthritis. J Rheumatol 35:1668–1675

    PubMed  Google Scholar 

  35. Sidiropoulou-Chatzigianni S, Papadopoulos MA, Kolokithas G (2008) Mandibular condyle lesions in children with juvenile idiopathic arthritis. Cleft Palate Craniofac J 45:57–62

    Article  PubMed  Google Scholar 

  36. Argyropoulou MI, Margariti PN, Karali A, Astrakas L, Alfandaki S, Kosta P, Siamopoulou A (2009) Temporomandibular joint involvement in juvenile idiopathic arthritis clinical predictors of magnetic resonance imaging signs. Eur Radiol 19:693–700

    Article  PubMed  Google Scholar 

  37. Arvidsson LZ, Smith H-J, Flatø B, Larheim TA (2010) Temporomandibular joint findings in adults with long-standing juvenile idiopathic arthritis: CT and MR imaging assessment. Radiology 256:191–200

    Article  PubMed  Google Scholar 

  38. Abramowicz S, Cheon JE, Kim S, Bacic J, Lee EY (2011) Magnetic resonance imaging of temporomandibular joints in children with arthritis. J Oral Maxillofac Surg 69:2321–2328

    Article  PubMed  Google Scholar 

  39. Koos B, Twilt M, Kyank U, Fischer-Brandies H, Gassling V, Tzaribachev N (2014) Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis. J Rheumatol 41:1871–1877

    Article  PubMed  Google Scholar 

  40. Komg H, Sieper J, Wolf KJ (1990) Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology 176:473–474

    Article  Google Scholar 

  41. Stoll ML, Sharpe T, Beukelman T, Good J, Young D, Cron RQ (2012) Risk factors for temporomandibular joint arthritis in children with juvenile idiopathic arthritis. J Rheumatol 39:1880–1887

    Article  PubMed  Google Scholar 

  42. Tzaribachev N, Fritz J, Horger M (2009) Spectrum of magnetic resonance imaging appearances of juvenile temporomandibular joints (TMJ) in non-rheumatic children. Acta Radiol 50:1182–1186

    Article  CAS  PubMed  Google Scholar 

  43. von Kalle T, Winkler P, Stuber T (2013) Contrast-enhanced MRI of normal temporomandibular joints in children—is there enhancement or not? Rheumatology (Oxford) 52:363–367

    Article  Google Scholar 

  44. Kottke R, Saurenmann RK, Schneider MM, Müller L, Grotzer MA, Kellenberger CJ. Contrast-enhanced MRI of the temporomandibular joint: findings in children without juvenile idiopathic arthritis. Acta Radiol. 2014 Sep 12. [Epub ahead of print]

  45. Vaid YN, Dunnavant FD, Royal SA, Beukelman T, Stoll ML, Cron RQ (2014) Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthritis Care Res 66:47–54

    Article  Google Scholar 

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Funding

This study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 07/56228-9).

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Authors and Affiliations

  1. Department of Pediatrics and Department of Radiology, Universidade Federal de São Paulo – UNIFESP, Rua Guilherme Moura, 95, 05449-010, São Paulo, SP, Brazil

    Liete M. L. Figueiredo Zwir, Maria Teresa R. A. Terreri, Soraia Ale Sousa, Artur Rocha Corrêa Fernandes, Antônio Sérgio Guimarães & Maria Odete E Hilário

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  1. Liete M. L. Figueiredo Zwir
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  2. Maria Teresa R. A. Terreri
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Correspondence to Liete M. L. Figueiredo Zwir.

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Zwir, L.M.L.F., Terreri, M.T.R.A., Sousa, S.A. et al. Are temporomandibular joint signs and symptoms associated with magnetic resonance imaging findings in juvenile idiopathic arthritis patients? A longitudinal study. Clin Rheumatol 34, 2057–2063 (2015). https://doi.org/10.1007/s10067-015-2925-y

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  • DOI: https://doi.org/10.1007/s10067-015-2925-y

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