Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging

Rheumatology (Oxford). 2009 Jun;48(6):680-5. doi: 10.1093/rheumatology/kep068. Epub 2009 Apr 22.


Objectives: To study the validity of both rheumatological and orthodontic examinations and ultrasound (US) as screening methods for early diagnosis of TMJ arthritis against the gold standard MRI.

Methods: Thirty consecutive juvenile idiopathic arthritis (JIA) patients were included in this pilot study. Rheumatological and orthodontic examinations as well as US were performed within 1 month of the MRI in a blinded fashion. Joint effusion and/or increased contrast enhancement of synovium or bone were considered signs of active arthritis on MRI.

Results: A total of 19/30 (63%) patients and 33/60 (55%) joints had signs of TMJ involvement on MRI. This was associated with condylar deformity in 9/19 (47%) patients and 15/33 (45%) joints. Rheumatological, orthodontic and US examinations correctly diagnosed 11 (58%), 9 (47%) and 6 (33%) patients, respectively, with active TMJ arthritis, but misdiagnosed 8 (42%), 10 (53%) and 12 (67%) patients, respectively, as having no signs of inflammation. The best predictor for active arthritis on MRI was a reduced maximum mouth opening.

Conclusion: None of the methods tested was able to reliably predict the presence or absence of MRI-proven inflammation in the TMJ in our cohort of JIA patients. US was the least useful of all methods tested to exclude active TMJ arthritis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Arthritis, Juvenile / diagnosis*
  • Arthritis, Juvenile / diagnostic imaging
  • Chi-Square Distribution
  • Child
  • Child, Preschool
  • Early Diagnosis
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging*
  • Male
  • Orthodontics
  • Physical Examination
  • Pilot Projects
  • Rheumatology
  • Sensitivity and Specificity
  • Temporomandibular Joint / diagnostic imaging
  • Temporomandibular Joint / pathology*
  • Temporomandibular Joint Disorders / diagnosis*
  • Temporomandibular Joint Disorders / diagnostic imaging
  • Ultrasonography