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Classification of temporomandibular joint erosion, arthritis, and inflammation in patients with juvenile idiopathic arthritis

Klassifikation der Erosion, Arthritis und Entzündung im Kiefergelenk bei juveniler idiopathischer Arthritis

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Abstract

Introduction

Juvenile idiopathic arthritis is the most common disease in pediatric rheumatology. It is characterized by chronically progressive joint destruction. The temporomandibular joints (TMJs) are involved in up to 87% of patients and may take an asymptomatic course in 69% of cases. Other than contrast-enhanced magnetic resonance imaging (MRI), there are no reliable screening symptoms or non-invasive procedures available to diagnose the inflammation in its acute form. The goal of this study was to establish an imaging-based classification system for TMJ erosion via MRI and cone-beam computed tomography (CBCT) in an effort to improve indication-specific treatment approaches and to facilitate the comparison of findings.

Materials and methods

A total of 46 patients were included. Contrast-enhanced MRI and CBCT images obtained during treatment by pediatric rheumatologists and orthodontists were available from 23 patients with juvenile idiopathic arthritis. We devised a classification system combining the findings of both imaging techniques based on this patient sample in comparison with CBCT findings from an age- and gender-matched group of 23 non-arthritis patients, taking into consideration the available literature and administration of contrast medium.

Results

Our cohort of 46 patients comprised 60% female and 40% male patients with a mean age of 14 years, providing a total of 92 TMJs for evaluation. We were able to apply the findings efficiently and conveniently to this classification system with no relevant interobserver differences. Mild structural abnormalities were noted in 21% of TMJs in the control group, whereas 83% of TMJs in the arthritis group exhibited severe anomalies, including cases of extreme destruction. Age and gender did not affect the degree of destruction significantly.

Conclusion

This is the first classification system to link CBCT and MRI with the use of contrast medium. Contrast-enhanced MRI is an internationally recognized technique that permits acute inflammation to be unequivocally diagnosed. Although structural erosion of the TMJs in our arthritis group was generally severe and significant, we were surprised to observe some cases that were clinically asymptomatic.

Zusammenfassung

Einleitung

Die juvenile idiopathische Arthritis (JIA) ist die häufigste Erkrankung in der Kinderrheumatologie. Im Krankheitsverlauf imponiert die chronisch progrediente Gelenkdestruktion mit Kiefergelenkbeteiligung bei bis zu 87% aller Patienten, die in 69% der Fälle asymptomatisch verlaufen kann. Es gibt weder zuverlässige Screeningsymptome noch nichtinvasive Verfahren zur Diagnose der akuten Entzündung. Diese ist mittels kontrastmittelgestützter Magnetresonanztomographie (KM-MRT) möglich. Ziel dieser Untersuchung ist die Klassifikation und Darstellung der Kiefergelenkerosion in MRT und digitaler Volumentomographie (DVT). Die Klassifikation soll Therapieindikation und Befundvergleich verbessern.

Material und Methode

Bei den eingeschlossenen 46 Patienten lagen von 23 kinderrheumatologisch und kieferorthopädisch behandelten JIA-Patienten behandlungsbedingt KM-MRT- und DVT-Aufnahmen vor. Unter Berücksichtigung der zur Verfügung stehenden Literatur und der Kontrastmittelgabe wurde eine beide Verfahren verknüpfende Klassifikation erstellt und anhand der vorliegenden Patienten, verglichen mit einer Kontrollgruppe von 23 Patienten ohne JIA, am DVT mit angepasster Alters- und Geschlechtsstruktur überprüft.

Ergebnisse

Insgesamt wurden 92 Gelenke von 46 Patienten untersucht, (w:m=40:60%; Altersdurchschnitt14 Jahre). Die Befunde waren eindeutig, praktikabel und effizient in die Klassifikation einzuordnen, relevante Unterschiede zwischen den Untersuchern traten nicht auf. In der Kontrollgruppe waren 21% der Gelenke strukturell leicht auffällig, in der Rheumagruppe imponierten 83% strukturell stark veränderte Gelenke (mit zum Teil hochgradiger Zerstörung). Alter und Geschlecht übten keinen statistischen Einfluss auf den Zerstörungsgrad aus.

Schlussfolgerungen

Bislang veröffentlichte Klassifikationen haben DVT und KM-MRT nicht miteinander verknüpft. Die KM-gestützte-MRT-Aufnahme ermöglicht die eindeutige Diagnose „akute Entzündung“ und ist international anerkannt. Signifikant war die generelle, starke strukturelle Erosion der Kiefergelenke in der Rheumagruppe, auffälligerweise zum Teil ohne klinische Symptomatik.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Interessenkonflikt

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Authors and Affiliations

  1. Department of Orthodontics, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany

    B. Koos & R. Ciesielski

  2. Department of Pediatric Rheumatology, Klinikum Bad Bramstedt, Bad Bramstedt, Germany

    N. Tzaribachev

  3. Department of Orthodontics, University of Tübingen, Tübingen, Germany

    S. Bott & A. Godt

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  1. B. Koos
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  2. N. Tzaribachev
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  4. R. Ciesielski
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Correspondence to B. Koos.

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Koos, B., Tzaribachev, N., Bott, S. et al. Classification of temporomandibular joint erosion, arthritis, and inflammation in patients with juvenile idiopathic arthritis. J Orofac Orthop 74, 506–519 (2013). https://doi.org/10.1007/s00056-013-0166-8

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