RESEARCH - Clinical, radiographic and MRI findings of the TMJ in patients with different rheumatic diseases

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Int J Oral Maxillofac Surg. 2006 Nov;35(11):983-9. Epub 2006 Oct 18.

Clinical, radiographic and MRI findings of the temporomandibular joint in

patients with different rheumatic diseases.

Departments of Oral and Maxillofacial Diseases, Helsinki University

Hospital, Helsinki, Finland. miia.helenius@...

The aim of this study was to investigate the condition of the

temporomandibular joint (TMJ) in patients with different rheumatic diseases,

and report correlations between the clinical, radiographic and magnetic

resonance imaging (MRI) findings. The 67 patients were divided into four

groups: 16 with rheumatoid arthritis (RA), 15 with mixed connective tissue

disease (MCTD), 18 with ankylosing spondylitis (AS) and 18 with

spondyloarthropathy (SPA). They were clinically examined, and panoramic

tomography, lateral panoramic radiography and MRI of the TMJ were performed.

MRI showed reduced articular cartilage in 25% (4/16) of RA, 0% (0/15) of

MCTD, 17% (3/18) of AS and 17% (3/18) of SPA patients. Condylar changes

included erosion, osteophytes and abnormal shape. Disc alterations included

perforation, abnormal anterior position and decreased movement. These

abnormalities were most frequent in RA patients, and least frequent in MCTD

and SPA patients. Crepitation and reduced maximum opening of the mouth

correlated with abnormalities of the disc and articular cartilage as shown

by MRI. Severe condylar erosion in panoramic tomograms significantly

correlated with MRI findings of condylar erosion (P<0.01), diminished

thickness of condylar cartilage, abnormal condylar shape, and abnormal shape

of the temporal surface of the TMJ (P< or =0.001). The presence of

crepitation, limited mandibular movement and/or pain on movement of the jaw

often indicated structural damage to the TMJ. Panoramic radiographs provide

an alternative method to MRI but, to obtain a more detailed anatomic

picture, MRI is recommended for patients with acute unexplained pain or as

part of preoperative work up. A panoramic recording is not indicated when

MRI is planned.

PMID: 17052893

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17052893

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