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Advances in Rheumatology

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Sumário

Research • Adv. rheumatol. 63 • 2023 • https://doi.org/10.1186/s42358-023-00285-4 copy

Does the use of panoramic radiography add information in the temporomandibular joint evaluation in Juvenile Idiopathic Arthritis patients? A case control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To determine the frequency of radiographic changes in the temporomandibular joint, in a representative population of patients with Juvenile Idiopathic Arthritis (JIA) and to compare with findings in healthy controls matched by sex and age.

Patients and Methods

One hundred and thirty-seven panoramic radiographies (PR) from JIA patients of a pediatric rheumatology outpatient clinic were prospectively evaluated and compared to 137 PR from healthy individuals.

Results

102 (74.5%) JIA patients and 47 (34.3%) controls showed at least one radiological alteration (p < 0.001). The following radiographic alterations were more frequently observed in JIA patients than in controls: erosion (p < 0.001), altered condylar morphology (p < 0.001), disproportion between condylar process and the coronoid process (p < 0.001) and accentuated curve in the antegonial notch (p = 0.002). Twenty patients (14.6%) presented the four radiographic alterations simultaneously compared to only two controls (1.5%) (p < 0.001).

Conclusion

Due to the difference in the frequency of findings in the PR of patients and controls, we concluded that PR has value as a screening tool. In the presence of major changes in the mandible head in the PR of patients with a confirmed diagnosis of JIA, MRI should be considered to detect an active inflammatory process in this joint.

Keywords
Panoramic radiography; Juvenile idiopathic arthritis; Rheumatic diseases; Diagnostic imaging; Temporomandibular joint

Female N (%)	Patients (137)		Controls (137)		p value
Female N (%)	106	(77.4)	106	(77.4)	1.000
Age at evaluation mean (± SD)	12.07	(± 4.4)	12	(± 4.3)	0.97
Age at diagnosis mean (± SD)	4	(± 3.6)
Disease duration mean (± SD)^ in years	7	(± 4.3^* * in one patient the data was unknown )
JIA^a a JIA —Juvenile Idiopathic Arthritis subtype Polyarticular N (%)	88	(64.2)
JIA^a a JIA —Juvenile Idiopathic Arthritis subtype Oligoarticular N (%)	37	(27.0)
JIA^a a JIA —Juvenile Idiopathic Arthritis subtype Systemic N (%)	12	(8.8)
Disease Activity N (%)	75	(54.7)

	Patients (137)		Controls (137)		p Value
	N	%	N	%	p Value
Erosion	46	33.6	12	8.8	< 0.001
Altered condylar morphology	72	52.6	10	7.3	< 0.001
Disproportion between COP^a a condylar process (COP) and the and CRP^b b coronoid process (CRP)	75	54.7	25	18.2	< 0.001
Accentuated antegonial notch	47	34.3	24	17.5	0.002
Presence of any alteration	102	74.5	47	34.3	< 0.001
Presence of all alterations	20	14.6	2	1.5	< 0.001
No alterations	35	25.5	90	65.7	< 0.001

	Sensitivity	CI 95%	Specificity	^c c CI—confidence interval; + CI 95%	+ ^d d PV—positive predictive value and -dPV—negative predictive value PV	^c c CI—confidence interval; + CI 95%	- ^d d PV—positive predictive value and -dPV—negative predictive value PV	CI 95%
Erosion	0.34	(0.25–0.42)	0.91	(0.85–0.95)	0.79	(0.66–0.88)	0.58	(0.50–0.64)
Altered condylar morphology	0.52	(0.43–0.61)	0.92	(0.86–0.96)	0.87	(0.78–0.93)	0.66	(0.58–0.72)
Disproportion between COP^a a condylar process (COP) and the and CRP^b	0.53	(0.46–0.63)	0.81	(0.74–0.87)	0.74	(0.65–0.83)	0.64	(0.56–0.71)
Accentuated antegonial notch	0.34	(0.26–0.42)	0.82	(0.75–0.88)	0.66	(0.53–0.77)	0.55	(0.48–0.62)
Presence of all alterations	0.14	(0.09–0.21)	0.98	(0.94–0.99)	0.90	(0.70–0.98)	0.53	(0.47–0.59)
No alterations	0.25	(0.18–0.33)	0.34	(0.26–0.35)	0.28	(0.20–0.35)	0.31	(0.24–0.39)

Variable	OR	IC95%	p
Erosion	5.26	(2.64–10.50)	< 0.001
Altered condylar morphology	14.07	(6.80–29.07)	< 0.001
Disproportion between COP^a a condylar process (COP) and the and CRP^b b coronoid process (CRP)	5.42	(3.13–9.38)	< 0.001
Accentuated antegonial notch	2.46	(1.39–4.32)	0.002

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E-mail: rbreumatol@terra.com.br

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