Is early TMJ involvement in children with juvenile idiopathic arthritis clinically detectable? Clinical examination of the TMJ in comparison with contrast enhanced MRI in patients with juvenile idiopathic arthritis.

Heidi Keller,Lukas Markus Müller,Rotraud Katharina Saurenmann,Christian Johannes Kellenberger,Goran Markic,Thomas Schraner

doi:10.1186/s12969-015-0056-2

Abstract

BackgroundTo test clinical findings associated with early temporomandibular joint (TMJ) arthritis in comparison to the current gold standard contrast enhanced magnetic resonance imaging (MRI) in children with juvenile idiopathic arthritis (JIA).MethodsSeventy-six consecutive JIA patients were included in this study. Rheumatological and orthodontic examinations were performed blinded to MRI findings. Joint effusion and/or increased contrast enhancement of synovium or bone as well as TMJ deformity were assessed on MRI and compared to clinical findings. The maximal mouth opening capacity (MOC) of the JIA patients was compared to normative values obtained from a cohort of 20719 school children from Zürich, Switzerland.ResultsOn MRI a total of 54/76 (71 %) patients and 92/152 (61 %) joints had signs of TMJ involvement. MRI showed enhancement in 85/152 (56 %) and deformity in 39/152 (26 %) joints. MOC, asymmetry and restriction in condylar translation showed significant correlation to TMJ enhancement and deformity, whereas antegonial notching was correlated with TMJ deformity only. When joints with deformity were excluded, enhancement alone did not show a significant correlation with any clinical factor.ConclusionsClinical findings in affected TMJs are correlated with structural damage only. Therefore clinical assessment of TMJs does not allow to diagnose early arthritis accurately and will still depend on contrast enhanced MRI.

Highlights

To test clinical findings associated with early temporomandibular joint (TMJ) arthritis in comparison to the current gold standard contrast enhanced magnetic resonance imaging (MRI) in children with juvenile idiopathic arthritis (JIA)
From 83 patients enrolled in the study, 7 patients were excluded: 2 patients because the interval between MRI and clinical examinations exceeded 3 months. 3 patients were not able to lie sufficiently still towards the end of MRI resulting in non-diagnostic contrast-enhanced images
In one patient, who had MRI performed under anaesthesia, the inflamed TMJ was injected with corticosteroids on the same occasion and before the orthodontic examination had taken place

Summary

Introduction

To test clinical findings associated with early temporomandibular joint (TMJ) arthritis in comparison to the current gold standard contrast enhanced magnetic resonance imaging (MRI) in children with juvenile idiopathic arthritis (JIA). The main growth centre of the mandible is located in the condyle separated from the joint space only by a thin layer of fibrocartilage. Detection of TMJ arthritis in children with JIA is difficult as early signs and symptoms are missing in most patients. Other studies reported an even lower prevalence of symptoms in case of TMJ arthritis [16, 17]. It is difficult to quantify the effect of TMJ involvement on the MOC in children with JIA as age matched controls are often missing in the literature

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