Evaluation of The Effects Of Rheumatoid Arthritis On The Hard And Soft Tissue Components Of The Temporomandibular Joint By Using Magnetic Resonance Imaging

Abstract

Background : Magnetic Resonance imaging (MRI) has been used to visualize the destructive effect of the Rheumatoid Arthritis ( RA) within the body joints , while Temporomandibular joint is often to be neglected. Aim of the study: observe the hard and soft tissue changes as well as the clinical involvement that may affect the TMJ in patients with longstanding RA. Patients and methods: 42 patients (84 TMJ’S), with mean age of (40.6 years) ranged from (28 to 63) years were divided into 2 groups; study (30) and control (12), all study group subjects consisted of patients with confirmed RA According to the criteria of American College Of Rheumatology (1987).Both groups have been examined clinically (at almustansiriya university/college of dentistry) and with MRI (at the MRI unit in alkadhmyia teaching hospital) in both sagital and coronal planes (open and close mouth) by the use of proton density and T2 weighted protocols. Results : The clinical involvement was present within (73.3%) of the study sample as the joint’s sounds was the predominant feature (80%) , masticatory muscle tenderness tenderness 70% , pain during function 58% ,morning stiffness 36.6% , deviation 43.3% while open bite was present in two cases (6.6%) , 33.3% of the RA patients had at least 3 clinical involvements , 26.6 % had at least 2 clinical involvement, uni-lateral involvement was present in 30% of RA patients, 5 subjects had only right side involvement and 4 patients had only left side involvement while bilateral involvement was present in 50% of RA patients. The mouth opening was significantly lowered (P<0.01) when compared with the control group.MRI findings was present in 80% of the study sample which lead to significant difference statistically when compared with the control group, the most common finding was the condylar head erosion (CHE), complete condylar destruction (score 4) was found in 2 RA patients, internal derangement 73.3%, meniscus perforation 73%, joint effusion 70%, increased joint space 66.6%, and osteophytes formation 60%, unilateral involvement was present in 53.3%, 5 subjects had right involvement only, and 7 subjects had left side involvement, while bilateral involvement was present in 46.7% . Key Words: Temporomandibular Joint, Rheumatoid Athritis , Magnatic Resonance Imaging , American College Of Rheumatology , Condylar Head Erosion.