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VOLUME 21 , ISSUE 7 ( July, 2020 ) > List of Articles

ORIGINAL RESEARCH

Role of CT Scan in Early Diagnosis of Temporomandibular Joint Injury in Patients with Rheumatoid Arthritis

Samia M AL-shaer

Citation Information : AL-shaer SM. Role of CT Scan in Early Diagnosis of Temporomandibular Joint Injury in Patients with Rheumatoid Arthritis. J Contemp Dent Pract 2020; 21 (7):769-775.

DOI: 10.5005/jp-journals-10024-2868

License: CC BY-NC 4.0

Published Online: 19-08-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims and objectives: Early detection of rheumatoid injury in the temporomandibular joint using CT, which accurately detects bone changes before the clinical symptoms start appearing to protect the joint from irreversible damage, and the correlation of those radiological changes with the duration of rheumatoid arthritis disease. Materials and methods: It included 45 people aged 27–74 years who reviewed the internal medicine and rheumatology clinics at Al-Mouwasat Hospital during 2016–2018 and are affected with rheumatoid arthritis according to the criteria American College of Arthritis (ACR) European League against Rheumatism (EULAR) 2010 criteria. The informed consent of the patient and the approval of the Scientific Research Council were obtained to conduct the research. Results: Computed tomography revealed the radiological changes in the left and right side, respectively, in terms of p value <0.05: (1) Erosion of condyle (42.22–53.34%). (2) Decreased in the joint space (53.33–60.00%). (3) Mandibular subchondral cysts in both sides (77.14%). (4) Erosion of the articular fossa (48.89–57.78%). (5) Flattening of condyle (46.67–55.55%). (6) Effusion (2.22–4.44%). (7) Bone marrow edema (26.67–40.00%). (8) Subchondral sclerosis (60.00–73.33%). Conclusion and clinical significance: The occurrence of bone damage in the condyle and articular fossa of the temporomandibular joint despite the fact that the sample members have no clinical complaint indicates the ability of CT scan of early and accurate disclosure of rheumatoid injury in the temporomandibular joint.


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  1. Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med 2001;344(12):907–916. DOI: 10.1056/NEJM200103223441207.
  2. Chen S, Gill MA, Luu CH, et al. Pain and rheumatoid arthritis: an update. Drug Topics 2000;3:47–56.
  3. Pincus T. Advantages and limitations of quantitative measures to assess rheumatoid arthritis: joint counts, radiographs, laboratory tests, and patient questionnaires. Bull NYU Hosp Jt Dis 2006; 64(1-2):32–39.
  4. Scott DL, Shipley M, Dawson A, et al. The clinical management of rheumatoid arthritis and osteoarthritis: strategies for improving clinical effectiveness. Br J Rheumatol 1998;37(5):546–554. DOI: 10.1093/rheumatology/37.5.546.
  5. Helenius LMJ, Tervahartiala P, Helenius I, et al. Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Maxillofac Surg 2006;35(11):983–989. DOI: 10.1016/j.ijom.2006.08.001.
  6. Koh ET, Yap AU, Koh CK, et al. Temporomandibular disorders in rheumatoid arthritis. J Rheumatol 1999;26(9):1918–1922.
  7. Hu YS, Schneiderman ED, Harper RP. The temporomandibular joint in juvenile rheumatoid arthritis: part II. Relationship between computed tomographic and clinical findings. Pediatr Dent 1996;18(4):312–319.
  8. Svensson B, Adell R, Kopp S. Temporomandibular disorders in juvenile chronic arthritis patients. A clinical study. Swed Dent J 2000;24(3):83–92.
  9. Yoshida A, Higuchi Y, Kondo M, et al. Range of motion of the temporomandibular joint in rheumatoid arthritis: relationship to the severity of disease. Cranio 1998;16(3):162–167. DOI: 10.1080/08869634.1998.11746054.
  10. McNeill C. Science and practice of occlusion. 1st ed. U S A Quintessence Books 1997. 538.
  11. Langland OE, Langlais RP, Preece JW. Principles of Dental Imaging. 2th ed., Philadelphia: Williams & Wilkins; 2002. 219–258.
  12. Melchiorre D, Calderazzi A, Maddali Bongi S, et al. Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint involvement in rheumatoid arthritis and psoriatic arthritis. Rheumatology 2003;42(5):673–676. DOI: 10.1093/rheumatology/keg181.
  13. Tehranzadeh J, Ashikyan O, Dascalos J. Magnetic resonance imaging in early detection of rheumatoid arthritis. Semin Musculoskelet Radiol 2003;7(2):79–94. DOI: 10.1055/s-2003-41342.
  14. McQueen FM, Benton N, Perry D, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003;48(7):1814–1827. DOI: 10.1002/art.11162.
  15. Radswiki, Gaillard Frank, Temporomandibular joint inflammation:N.D. © 2005–2017 Radiopaedia.org.
  16. Holberg C, Steinhäuser S, Geis P, et al. Cone-beam computed tomography in orthodontics: benefits and limitations. J Orofac Orthop 2005;66(6):434–444. DOI: 10.1007/s00056-005-0519-z.
  17. Miraclea AC, Mukherjia SK. Cone beam CT of the head and neck, part 1: physical principles. Journal of Neuroradiology 2009;30(6):1088–1095. DOI: 10.3174/ajnr.A1653.
  18. Goswami R, Arora P, Gaba N, et al. Insights of TMJ through advanced imaging. Research 2015;6(01):1–7.
  19. Goldman. LW. Principles of CT and CT technology. J Nucl Med Technol 2007;35(3):115–128. DOI: 10.2967/jnmt.107.042978.
  20. Shapurian T, Damoulis PD, Reiser GM, et al. Quantitative evaluation of bone density using the Hounsfield index. Int J Oral Maxillofac Implants 2006;21(2):290–297.
  21. Aletaha D, Neogi T, Silman AJ, et al. Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2010;69(9):1580–1588. DOI: 10.1136/ard.2010.138461.
  22. Witulski S, Vogl TJ, Rehart S, et al. Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis. Biomed Res Int 2014;2014:328560. DOI: 10.1155/2014/328560.
  23. Bayar N, Kara SA, Keles I, et al. Temporomandibular joint involvement in rheumatoid arthritis: a radiological and clinical study. Cranio 2002;20(2):105–110. DOI: 10.1080/08869634.2002.11746198.
  24. Bag AK, Gaddikeri S, Singhal A, et al. Imaging of the temporomandibular joint. World J Radiol 2014;6(8):567–582. DOI: 10.4329/wjr.v6.i8.567.
  25. Greenberg MS, Glick M, Ship JA. Burket's Oral Medicine. 11th ed., India: BC Decker Inc Hamilton; 2008;9:223–255.
  26. Subchondral bone cyst: Causes, treatment, and symptoms. Jayne Leonard. 17 August 2017, https://www.medicalnewstoday.com/articles/318976.php.
  27. Wakefield RJ, Kong KO, Conaghan PG, et al. The role of ultrasonography and magnetic resonance imaging in early rheumatoid arthritis. Clin Exp Rheumatol 2003;31(5 Suppl 31):S42–S49.
  28. Burde KN, Naikmasur VG, Sattur AP. Assessment of condylar changes in patients with temporomandibular joint pain using digital volumetric tomography: radiology research and practice. 2014;2014:106059.
  29. Larheim TA, Katzberg RW, Westesson PL, et al. MR evidence of temporomandibular joint fluid and condyle marrow alterations: occurrence in asymptomatic volunteers and symptomatic patients. J Oral Maxillofac Surg 2001;30(2):113–117. DOI: 10.1054/ijom.2000. 0018.
  30. https://www.verywell.com > Conditions > Osteoarthritis > Diagnosis.
  31. Larheim TA, Tveito L, Dale K, et al. Temporomandibular joint abnormalities in rheumatoid arthritis: comparison of different radiographic methods. Acta Radiol Diagn (Stockh) 1981;22(6):703–707. DOI: 10.1177/028418518102200615.
  32. Holmlund AB, Gynther G, Reinholt FP. Rheumatoid arthritis derangement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1992;73(3):273–277. DOI: 10.1016/0030-4220(92)90119-b.
  33. Sinha VP, Pradhan H, Gupta H, et al. Efficacy of plain radiographs, CT scan, MRI and ultra sonography in temporomandibular joint disorders. Natl J Maxillofac Surg 2012;3(1):2–9. DOI: 10.4103/0975-5950.102138.
  34. Celiker R, Gökçe-Kutsal Y, Eryilmaz M. Temporomandibular joint involvement in rheumatoid arthritis. relationship with disease activity. Scand Rheumatol 1995;24(1):22–25. DOI: 10.3109/03009749509095149.
  35. Goupille P, Fouquet B, Cotty P, et al. Temporomandibular joint and rheumatoid polyarthritis. X-ray computed tomographic aspects. J Radiol 1992;73(4):253–261.
  36. Kretapirom K, Okochi K, Nakamura S, et al. MRI characteristics of rheumatoid arthritis in the temporomandibular joint. Dentomaxillofac Radiol 2013;42(4):31627230. DOI: 10.1259/dmfr/31627230.
  37. Syrjanen SM. The temporomandibular joint in rheumatoid arthritis. Acta Radio1 Diagn (Stockh) 1985;26(3):235–243. DOI: 10.1177/028418518502600302.
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