The online version of this article (https://doi.org/10.1186/s12969-018-0223-3) contains supplementary material, which is available to authorized users.
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.
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.
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).
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.
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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
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
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
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.
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
Stoll ML, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis: the last frontier. Int J Clin Rheumatol. 2015;10:273–86. CrossRef
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.
- 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
Matthew L. Stoll
Melissa L. Mannion
Daniel W. Young
Stuart A. Royal
Randy Q. Cron
Yoginder N. Vaid
- BioMed Central