Heterotopic Ossification of the Temporomandibular Joint in JIA

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Heterotopic Ossification of the Temporomandibular Joint in Juvenile

Idiopathic Arthritis

http://jrheum.org/content/early/2011/04/11/jrheum.101198.abstract

Address correspondence to Dr. S. Ringold, Seattle Children’s Hospital, 4800

Sandpoint Way NE, Seattle, WA 98105. E-mail:

.Ringold@...

Accepted for publication February 11, 2011.

Abstract

Objective To describe the clinical, laboratory, pathologic, and radiographic

imaging characteristics of a series of children with juvenile idiopathic

arthritis (JIA) and radiographic imaging evidence of heterotopic

ossification of their temporomandibular joint (TMJ).

Methods Children were identified through search of an administrative

database of imaging results at Seattle Children’s Hospital. Retrospective

chart review was performed to collect data on each patient’s clinical and

laboratory characteristics, systemic therapies, timing and number of TMJ

intraarticular corticosteroid injections (IAS), TMJ symptoms, and TMJ

findings on physician examination. TMJ imaging studies for which heterotopic

ossifications were reported were reviewed. Pathology specimens were reviewed

for the 2 children who underwent synovial biopsy of their TMJ.

Results Twelve children were identified. The average duration between onset

of JIA and detection of heterotopic ossification of TMJ on an imaging study

was 36 months (range 19–94). Half the children had abnormal mouth-opening

for age when the calcifications were first detected. In each case, the

heterotopic ossification was first detected by computed tomography scan, and

in 11 of the cases they were associated with synovial pannus formation as

documented on an imaging study. Two children underwent synovial biopsy,

which revealed reactive parosteal osteochondromatosis in one case and

findings consistent with an intraarticular rheumatoid nodule in the other.

Conclusion Heterotopic ossifications of the TMJ may be seen in children with

JIA and are associated with particularly severe TMJ arthritis, joint

destruction, and pannus formation. Pathology from these joints suggests that

the heterotopic ossification may result from multiple pathological

processes.