Skip to main content

Advertisement

SpringerLink
Log in

Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

MRI manifestation of temporomandibular joint arthritis is frequently reported in children with juvenile idiopathic arthritis. However, little attention has been paid to temporomandibular joint disk abnormalities.

Objective

To assess combinations of MRI findings in the symptomatic temporomandibular joint in children with juvenile idiopathic arthritis with focus on disk abnormalities.

Materials and methods

This was a retrospective study of 46 patients with juvenile idiopathic arthritis, mean age 12 years (range: 5-17 years). Mean disease duration was 70 months (standard deviation: 61 months). MR images of 92 temporomandibular joints were scored for thickness of abnormally enhancing synovium (synovitis), joint effusion, bone marrow oedema, abnormal bone shape, bone erosion and disk abnormalities.

Results

The 92 temporomandibular joints were categorized as A: No synovitis and normal bone shape (30/92; 33%), B: Synovitis and normal bone shape (14/92: 15%), C: Synovitis and abnormal bone shape (38/92; 41%) and D: No synovitis but abnormal bone shape (10/92; 11%). Thirty-six of the 46 patients (78%) had synovitis and 33/46 (72%) had abnormal bone shape, most frequently in combination (30/46; 65%). Disk abnormalities (flat disk, fragmented disk, adherent disk and displaced disk) were found in 29/46 patients (63%). Disk abnormalities were found in all categories of juvenile idiopathic arthritis involved temporomandibular joints (B: 8/14 [57%]; C: 25/38 [66%] and D: 7/10 [70%]). Disk displacement was found in half of the joints (7/14) in category B. Synovitis was most pronounced in this category.

Conclusion

Disk abnormalities were frequent. Disk displacement also occurred in joints with early temporomandibular joint arthritis, i.e., with normal bone shape. Other disk abnormalities were found in joints with bone abnormalities. Attention should be paid to disk abnormalities both in early and long-standing temporomandibular joint arthritis in children with juvenile idiopathic arthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Berntson L, Andersson Gäre B, Fasth A et al (2003) Incidence of juvenile idiopathic arthritis in the Nordic countries. A population based study with special reference to the validity of the ILAR and EULAR criteria. J Rheumatol 30:2275–2282

    PubMed  Google Scholar 

  2. Riise ØR, Handeland KS, Cvancarova M et al (2008) Incidence and characteristics of arthritis in Norwegian children: a population-based study. Pediatrics 121:e299–e306

    Article  PubMed  Google Scholar 

  3. Moe N, Rygg M (1998) Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study. Clin Exp Rheumatol 16:99–101

    CAS  PubMed  Google Scholar 

  4. Ravelli A, Martini A (2007) Juvenile idiopathic arthritis. Lancet (Lond) 369:767–778

    Article  CAS  Google Scholar 

  5. Arvidsson L, Smith H-J, Flatø B et al (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 

  6. Larheim TA, Smith HJ, Aspestrand F (1990) Rheumatic disease of the temporomandibular joint: MR imaging and tomographic manifestations. Radiology 175:527–531

    Article  CAS  PubMed  Google Scholar 

  7. 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 

  8. Damasio MB, Malattia C, Martini A et al (2010) Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol 40:985–998

    Article  PubMed  Google Scholar 

  9. Abramowicz S, Cheon J-E, Kim S et al (2011) Magnetic resonance imaging of temporomandibular joints in children with arthritis. J Oral Maxillofac Surg 69:2321–2328

    Article  PubMed  Google Scholar 

  10. Stoll M, Sharpe T, Beukelman T et al (2012) Risk factors for temporomandibular joint arthritis in children with juvenile idiopathic arthritis. J Rheumatol 39:1880–1887

    Article  PubMed  Google Scholar 

  11. Koos B, Twilt M, Kyank U et al (2014) Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis. J Rheumatol 41:1871–1877

    Article  PubMed  Google Scholar 

  12. Vaid Y, Dunnavant FD, Royal S et al (2014) Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthritis Care Res 66:47–54

    Article  Google Scholar 

  13. Meyers A, Laor T (2013) Magnetic resonance imaging of the temporomandibular joint in children with juvenile idiopathic arthritis. Pediatr Radiol 43:1632–1641

    Article  PubMed  Google Scholar 

  14. 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 

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

    Article  Google Scholar 

  16. Kottke R, Saurenmann RK, Schneider MM et al (2014) Contrast-enhanced MRI of the temporomandibular joint: findings in children without juvenile idiopathic arthritis. Acta Radiol 59:1145–1152

    Google Scholar 

  17. Cahill AM, Baskin KM, Kaye RD et al (2007) CT-guided percutaneous steroid injection for management of inflammatory arthropathy of the temporomandibular joint in children. AJR Am J Roentgenol 188:182–186

    Article  PubMed  Google Scholar 

  18. Kuseler A, Pedersen TK, Herlin T et al (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 

  19. Weiss PF, Arabshahi B, Johnson A et al (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 

  20. Müller L, Kellenberger CJ, Cannizzaro E 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 48:680–685

    Article  PubMed Central  PubMed  Google Scholar 

  21. Argyropoulou MI, Margariti PN, Karali A et al (2009) Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs. Eur Radiol 19:693–700

    Article  PubMed  Google Scholar 

  22. Cannizzaro E, Schroeder S, Muller LM et al (2011) Temporomandibular joint involvement in children with juvenile idiopathic arthritis. J Rheumatol 38:510–515

    Article  PubMed  Google Scholar 

  23. Taylor DB, Babyn P, Blaser S et al (1993) MR evaluation of the temporomandibular joint in juvenile rheumatoid arthritis. J Comput Assist Tomogr 17:449–454

    Article  CAS  PubMed  Google Scholar 

  24. Petty R, Southwood T, Manners P 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 

  25. Giannini EH, Ruperto N, Ravelli A et al (1997) Preliminary definition of improvement in juvenile arthritis. Arthritis Rheum 40:1202–1209

    Article  CAS  PubMed  Google Scholar 

  26. Brooks SL, Westesson PL, Eriksson L et al (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 

  27. Karlo CA, Stolzmann P, Habernig S et al (2010) Size, shape and age-related changes of the mandibular condyle during childhood. Eur Radiol 20:2512–2517

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  29. Larheim TA (1981) Radiographic appearance of the normal temporomandibular joint in newborns and small children. Acta Radiol Diagn 22:593–599

    Article  CAS  Google Scholar 

  30. Yamada M, Matsuzaka T, Uetani M et al (1995) Normal age-related conversion of bone marrow in the mandible: MR imaging findings. AJR Am J Roentgenol 165:1223–1228

    Article  CAS  PubMed  Google Scholar 

  31. Morimoto Y, Tominaga K, Konoo T et al (2004) Detection and significance of the characteristic magnetic resonance signals of mandibular condyles in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 97:269–275

    Article  PubMed  Google Scholar 

  32. Lei J, Liu MQ, Yap AU et al (2013) Condylar subchondral formation of cortical bone in adolescents and young adults. Br J Oral Maxillofac Surg 51:63–68

    Article  PubMed  Google Scholar 

  33. Morimoto Y, Konoo T, Tominaga K et al (2007) Relationship between cortical bone formation on mandibular condyles and alternation of the magnetic resonance signals characteristic of growth. Am J Orthod Dentofacial Orthop 131:473–480

    Article  PubMed  Google Scholar 

  34. Drace JE, Enzmann DR (1990) Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects. Radiology 177:67–71

    Article  CAS  PubMed  Google Scholar 

  35. Larheim TA, Westesson P, Sano T (2001) Temporomandibular joint disk displacement: comparison in asymptomatic volunteers and patients. Radiology 218:428–432

    Article  CAS  PubMed  Google Scholar 

  36. Larheim TA, Katzberg RW, Westesson PL et al (2001) MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients. Int J Oral Maxillofac Surg 30:113–117

    Article  CAS  PubMed  Google Scholar 

  37. Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386

    PubMed  Google Scholar 

  38. Larheim TA, Smith HJ, Aspestrand F (1991) Rheumatic disease of temporomandibular joint with development of anterior disk displacement as revealed by magnetic resonance imaging. A case report. Oral Surg Oral Med Oral Pathol 71:246–249

    Article  CAS  PubMed  Google Scholar 

  39. 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 

  40. Ringold S, Cron RQ (2009) The temporomandibular joint in juvenile idiopathic arthritis: frequently used and frequently arthritic. Pediatr Rheumatol Online J 7:11

    Article  PubMed Central  PubMed  Google Scholar 

  41. Tominaga K, Konoo T, Morimoto Y et al (2007) Changes in temporomandibular disc position during growth in young Japanese. Dentomaxillofac Radiol 36:397–401

    Article  CAS  PubMed  Google Scholar 

  42. Suenaga S, Hamamoto S, Kawano K et al (1996) Dynamic MR imaging of the temporomandibular joint in patients with arthrosis: relationship between contrast enhancement of the posterior disk attachment and joint pain. AJR Am J Roentgenol 166:1475–1481

    Article  CAS  PubMed  Google Scholar 

  43. Farina D, Bodin C, Gandolfi S et al (2009) TMJ disorders and pain: assessment by contrast-enhanced MRI. Eur J Radiol 70:25–30

    Article  PubMed  Google Scholar 

  44. Kuseler A, Pedersen T, Gelineck J et al (2005) A 2 year followup 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 

  45. Alkhader M, Ohbayashi N, Tetsumura A et al (2010) Diagnostic performance of magnetic resonance imaging for detecting osseous abnormalities of the temporomandibular joint and its correlation with cone beam computed tomography. Dentomaxillofac Radiol 39:270–276

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Postbox 4950, Nydalen, N-0424, Oslo, Norway

    Eva Kirkhus & Hans-Jørgen Smith

  2. Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Berit Flatø & Siri O. Hetlevik

  3. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Eva Kirkhus, Hans-Jørgen Smith, Berit Flatø & Siri O. Hetlevik

  4. Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway

    Linda Z. Arvidsson & Tore A. Larheim

Authors
  1. Eva Kirkhus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda Z. Arvidsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans-Jørgen Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Berit Flatø
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siri O. Hetlevik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tore A. Larheim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva Kirkhus.

Ethics declarations

Conflicts of interest

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirkhus, E., Arvidsson, L.Z., Smith, HJ. et al. Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis. Pediatr Radiol 46, 331–341 (2016). https://doi.org/10.1007/s00247-015-3493-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-015-3493-7

Keywords

Search

Navigation