Pediatric Rheumatology Online Journal → June 2003 → Miscellaneous Topics→ Abstract #83

DIAGNOSTIC VALUE OF ORTOPANTOMOGRAPHY COMPARED TO MAGNETIC RESONANCE IMAGING OF THE TEMPOROMANDIBULAR JOINT IN JUVENILE IDIOPATHIC ARTHRITIS

T. K. Pedersen,1 A. Kuseler,1 J. Gelineck,2 T. Herlin.3

1Institute of Orthodontics, Aarhus Dentist School, University of Aarhus, Aarhus C, Denmark; 2Radiology, Aarhus Kommunehospital, University of Aarhus, Aarhus C, Denmark; 3Pediatrics, Skejby Sygehus, University of Aarhus, Aarhus N, Denmark

Introduction: Arthritis in the temporomandibular joint (TMJ) is a frequent finding in juvenile idiopathic arthritis (JIA). It may be characterized by few symptoms and modest clinical findings although the TMJ arthritis may impair the development of the lower face dramatically. Early functional treatment seems to have an effect in controlling the growth disturbances if intervention is started before deformities are presented.
Aim: To prospectively describe the development of arthritis in the TMJ in a 2-year period in JIA patients with disease duration no longer than three years.
Patients & methods: Fifteen consecutively selected patients with JIA were included. Magnetic resonance imaging (MRI) and orthopantomogram (OTP) examinations contemporary with clinical examinations were performed four times with 6-8 months intervals. The MRI examinations included Gd-DTPA enhanced images to reveal possible inflammatory changes and were described according to soft tissue and bone changes. The OTP's were described according to the degree of resorption of the condyle.
Results: 30.0 % of the patients had condylar resorptions according to the OTP and there were no significant changes observed in the two-year period. With MRI 58.6% showed erosions at the first examination the difference compared to OTP being statistically significant (p

0.05, chi-test) and the frequency of resorptive changes increased to 80.0 % at the last examination. Clinical examination indicated inflammation by decrease of opening capacity ( 40 mm) and lack of palpable translation of the condylar head.
Conclusion: The diagnostic sensitivity of OTP which is an often used screening method for investigating arthritis in TMJ is too low and cannot be recommended to find early TMJ involvement. Monitoring changes in TMJ function seem to be more reliable and functional inability should be the indication for functional treatment rather than radiographic changes.