CASE REPORT

 

Juvenile idiopathic arthritis with involvement of the temporomandibular joint: the role of image examinations

 

Artrite idiopática juvenil com envolvimento da articulação temporomandibular: o papel dos exames por imagens entre os recursos de diagnóstico

 

 

Karina Ivette Sánchez Effio^I; Luciana Maria Paes da Silva; Ramos Fernandes^II; Marcelo Eduardo Pereira Dutra^III; Marcelo Marcucci^IV; Jefferson Xavier de Oliveira^V

^IPrivate practice, Lima, Peru
^IIGraduate Program in Stomatology, Bauru Dental School, University of São Paulo, Bauru, SP, Brazil
^IIIUniversity Santa Cecília, Santos, SP, Brazil
^IV Department of Stomatology and Oral-Maxillo-facial Surgery, Heliópolis Hospital, São Paulo, SP, Brazil
^VDiscipline of Radiology, Dental School, University of São Paulo, São Paulo, SP, Brazil

Correspondence

 

 

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ABSTRACT

PURPOSE: Juvenile idiopathic arthritis (JIA) has unknown etiology, and the involvement of the temporomandibular joint (TMJ) is rare in the early phase of the disease. The present article describes the use of computed tomography (CT) and magnetic resonance (MRI) images for the diagnosis of affected TMJ in JIA.
CASE DESCRIPTION: A 12-year-old, female, Caucasian patient, with systemic rheumathoid arthritis and involvement of multiple joints was referred to the Imaging Center for TMJ assessment. The patient reported TMJ pain and limited opening of the mouth. The helical CT examination of the TMJ region showed asymmetric mandibular condyles, erosion of the right condyle and osteophyte-like formation. The MRI examination showed erosion of the right mandibular condyle, osteophytes, displacement without reduction and disruption of the articular disc.
CONCLUSION: The disorders of the TMJ as a consequence of JIA must be carefully assessed by modern imaging methods such as CT and MRI. CT is very useful for the evaluation of discrete bone changes, which are not identified by conventional radiographs in the early phase of JIA. MRI allows the evaluation of soft tissues, the identification of acute articular inflammation and the differentiation between pannus and synovial hypertrophy.

Key words: Juvenile idiopathic arthritis; temporomandibular joint; computed tomography; magnetic resonance imaging

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RESUMO

OBJETIVO: A artrite idiopática juvenil (AIJ) tem etiologia desconhecida e o envolvimento da articulação temporomandibular (ATM) é raro no estágio inicial da doença. Este artigo descreve o uso de imagens de tomografia computadorizada (TC) e de ressonância magnética (RM) para o diagnóstico de ATM afetada pela AIJ.
DESCRIÇÃO DO CASO: Uma paciente de 12 anos de idade, leucoderma, portadora de AIJ com envolvimento de múltiplas articulações foi encaminhada ao Centro de Imaginologia para avaliação das ATMs. A paciente relatou dor na ATM e limitação de abertura bucal. O exame com TC helicoidal da região da ATM com reconstruções a 1 mm mostrou assimetria entre os côndilos mandibulares, erosão do côndilo direito e formação osteofítica. O exame de RM mostrou erosão do côndilo mandibular direito, osteófito, deslocamento sem redução e ruptura do disco articular.
CONCLUSÃO: As desordens de ATM devido à AIJ devem ser cuidadosamente examinadas por modernas técnicas de imagem. A TC é muito útil para a detecção e avaliação de estruturas ósseas da ATM e permite o exame de alterações ósseas discretas, que não seriam identificadas por radiografias convencionais nas fases iniciais de AIJ. A RM permite a avaliação de tecidos moles, identificação de inflamação articular aguda e diferenciação entre hipertrofia sinovial e do pannus.

Palavras-chave: Artrite idiopática juvenil; articulação temporomandibular; tomografia computadorizada; ressonância magnética

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Correspondence:
Karina Ivette Sánchez Effio
Calle La Begonia 183 Urb. Los Sauces
Surquillo Lima 34
Lima - Peru
E-mail: karinasanchezeffio@gmail.com

Received: December 11, 2008
Accepted: September 8, 2009