TEMPOROMANDIBULAR JOINT ARTHRITIS AND THE ROLE OF IMAGING

Temporomandibular joints (TMJs) are complex ginglymoarthrodial articulations. TMJs comprise synovium and can be affected by chronic synovitis. TMJ involvement occurs in up to 50% of children with juvenile idiopathic arthritis (JIA) and can occur in rheumatoid arthritis (RA), too. TMJ arthritis and its sequelae have significant impact on the function of TMJs and affect quality of life profoundly. In children, early onset TMJ arthritis causes growth disturbances of the mandible with severe cosmetic, dental and functional sequelae. Early diagnosis and treatment are thus essential to prevent permanent damage. Subjective complaints (pain, stiffness, crepitation) have low sensitivity (26%) and even may not be reported by patients with TMJ arthritis. Objective findings (tenderness, crepitation, limited mouth opening or deviation of the mandible) have a somewhat higher sensitivity (26–64%), but are not specific for TMJ arthritis. In children, sequential measurement of the inter-incisor distance and its assessment with age-specific reference values can be helpful. Ultrasound, despite its many advantages, has low sensitivity, but may be a useful screening method. X-rays and X-ray based assessments visualize mainly sequelae of arthritis (erosions, growth abnormalities).Among these, cone-beam CT provides the highest accuracy with a low exposure to radiation. Contrast enhanced MRI can visualize active synovitis in TMJs, differentiate active disease from its sequelae and thus determine the need for therapy, as well as its effectiveness. In summary, TMJ arthritis is frequent, has the potential to cause permanent damage and is difficult to diagnose clinically. Imaging techniques improve diagnostic accuracy, among these contrast-enhanced MRI a cone-beam CT are most helpful for identification of active synovitis and its sequelae, respectively. References: 1. Abramowicz S, Cheon JE, Kim S, et al. Magnetic resonance imaging of temporomandibular joints in children with arthritis. J Oral Maxillofac Surg. 2011 Sep;69(9):2321–8. doi: 10.1016/j.joms.2010.12.058 2. Rehan OM, Saleh HAK, Raff at HA, et al. Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study. Imaging Sci Dent. 2018 Mar;48(1):1–9. doi: 10.5624/isd.2018.48.1.1. 3. Hsieh YJ, Darvann TA, Hermann NV, Larsen et al. Facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint involvement. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):182–91. doi: 10.1016/j.ajodo.2015.07.033. 4. Caruso P, Buch K, Rincon S, et al. Optimization of Quantitative Dynamic Postgadolinium MRI Technique Using Normalized Ratios for the Evaluation of Temporomandibular Joint Synovitis in Patients with Juvenile Idiopathic Arthritis. AJNR Am J Neuroradiol. 2017 Dec;38(12):2344–2350. doi: 10.3174/ajnr.A5424

TEMPOROMANDIBULAR JOINT ARTHRITIS AND THE ROLE OF IMAGING

Temporomandibular joints (TMJs) are complex ginglymoarthrodial articulations. TMJs comprise synovium and can be affected by chronic synovitis. TMJ involvement occurs in up to 50% of children with juvenile idiopathic arthritis (JIA) and can occur in rheumatoid arthritis (RA), too. TMJ arthritis and its sequelae have significant impact on the function of TMJs and affect quality of life profoundly. In children, early onset TMJ arthritis causes growth disturbances of the mandible with severe cosmetic, dental and functional sequelae. Early diagnosis and treatment are thus essential to prevent permanent damage. Subjective complaints (pain, stiffness, crepitation) have low sensitivity (26%) and even may not be reported by patients with TMJ arthritis. Objective findings (tenderness, crepitation, limited mouth opening or deviation of the mandible) have a somewhat higher sensitivity (26–64%), but are not specific for TMJ arthritis. In children, sequential measurement of the inter-incisor distance and its assessment with age-specific reference values can be helpful. Ultrasound, despite its many advantages, has low sensitivity, but may be a useful screening method. X-rays and X-ray based assessments visualize mainly sequelae of arthritis (erosions, growth abnormalities).Among these, cone-beam CT provides the highest accuracy with a low exposure to radiation. Contrast enhanced MRI can visualize active synovitis in TMJs, differentiate active disease from its sequelae and thus determine the need for therapy, as well as its effectiveness. In summary, TMJ arthritis is frequent, has the potential to cause permanent damage and is difficult to diagnose clinically. Imaging techniques improve diagnostic accuracy, among these contrast-enhanced MRI a cone-beam CT are most helpful for identification of active synovitis and its sequelae, respectively. References: 1. Abramowicz S, Cheon JE, Kim S, et al. Magnetic resonance imaging of temporomandibular joints in children with arthritis. J Oral Maxillofac Surg. 2011 Sep;69(9):2321–8. doi: 10.1016/j.joms.2010.12.058 2. Rehan OM, Saleh HAK, Raff at HA, et al. Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study. Imaging Sci Dent. 2018 Mar;48(1):1–9. doi: 10.5624/isd.2018.48.1.1. 3. Hsieh YJ, Darvann TA, Hermann NV, Larsen et al. Facial morphology in children and adolescents with juvenile idiopathic arthritis and moderate to severe temporomandibular joint involvement. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):182–91. doi: 10.1016/j.ajodo.2015.07.033. 4. Caruso P, Buch K, Rincon S, et al. Optimization of Quantitative Dynamic Postgadolinium MRI Technique Using Normalized Ratios for the Evaluation of Temporomandibular Joint Synovitis in Patients with Juvenile Idiopathic Arthritis. AJNR Am J Neuroradiol. 2017 Dec;38(12):2344–2350. doi: 10.3174/ajnr.A5424

VCAM-1 serum levels are associated with arthropathy in hereditary haemochromatosis

Objectives: The aim of this study was to assess the role of vascular adhesion molecule 1 (VCAM-1) in patients with hereditary haemochromatosis (HH) with or without arthropathy. Methods: Sera from a large cross-sectional cohort of unselected HH patients (n=147) were obtained and compared to an age-matched and sex-matched control group. Serum levels of VCAM-1 were measured by ELISA and were correlated with clinical measures. Results: VCAM-1 serum levels were elevated in HH patients as compared to matched controls (mean 913±456 vs 654±451 ng/ml, p<0.0001). Within the HH patient group, VCAM-1 levels were much higher in patients with arthropathy and joint replacement surgery. VCAM-1 levels correlated well with radiographic measures of HH arthropathy (r=0.36, p<0.0001). Multivariate regression analysis confirmed a highly significant association of VCAM-1 serum levels and the presence of HH arthropathy, independent from diabetes, body mass index and age. Conclusions: VCAM-1 serum levels emerge as a biomarker for haemochromatosis arthropathy