DOI QR코드

DOI QR Code

Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study

  • Rehan, Ola Mohamed (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University) ;
  • Saleh, Hoda Abdel Kader (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University) ;
  • Raffat, Hala Ahmed (Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University) ;
  • Abu-Taleb, Noha Saleh (Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University)
  • 투고 : 2017.05.31
  • 심사 : 2018.01.24
  • 발행 : 2018.03.31

초록

Purpose: To evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings. Materials and Methods: This study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed. Results: According to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results. Conclusion: RA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.

키워드

참고문헌

  1. Yilmaz HH, Yildirim D, Ugan Y, Tunc SE, Yesildag A, Orhan H, et al. Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis. Rheumatol Int 2012; 32: 1171-8. https://doi.org/10.1007/s00296-010-1743-4
  2. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician 2005; 72: 1037-47.
  3. Kretapirom K, Okochi K, Nakamura S, Tetsumura A, Ohbayashi N, Yoshino N, et al. MRI characteristics of rheumatoid arthritis in the temporomandibular joint. Dentomaxillofac Radiol 2013; 42: 31627230. https://doi.org/10.1259/dmfr/31627230
  4. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum 2002; 46: 328-46. https://doi.org/10.1002/art.10148
  5. Assasi N, Blackhouse G, Campbell K, Hopkins RB, Levine M, Richter T, et al. Comparative value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) testing in combination versus individually for the diagnosis of undifferentiated patients with suspected inflammatory disease or serious infection: a systematic review and economic analysis. Ottawa, ON: Canadian Agency for Drugs and Technologies in Health; 2015.
  6. Campos PS, Reis FP, Aragao JA. Morphofunctional features of the temporomandibular joint. Int J Morphol 2011; 29: 1394-7. https://doi.org/10.4067/S0717-95022011000400055
  7. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med 2008; 359: 2693-705. https://doi.org/10.1056/NEJMra0802472
  8. Campos JA, Carrascosa AC, Bonafe FS, Maroco J. Severity of temporomandibular disorders in women: validity and reliability of the Fonseca Anamnestic Index. Braz Oral Res 2014; 28: 16-21. https://doi.org/10.1590/S1806-83242013005000026
  9. Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-60. https://doi.org/10.1016/j.tripleo.2009.02.023
  10. Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, et al. Imaging of the temporomandibular joint: an update. World J Radiol 2014; 6: 567-82. https://doi.org/10.4329/wjr.v6.i8.567
  11. Perschbacher S. Temporomandibular joint abnormalities. In: White SC, Pharoah MJ. Oral radiology: principles and interpretation. 7th ed. St. Louis: Mosby-Year Book Inc; 2014. p.492-523.
  12. Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M, Yorgancioglu R. The comprehensive evaluation of temporomandibular disorders seen in rheumatoid arthritis. Aust Dent J 2006; 51: 23-8. https://doi.org/10.1111/j.1834-7819.2006.tb00396.x
  13. Cara AC, Gaia BF, Perrella A, Oliveira JX, Lopes PM, Cavalcanti MG. Validity of single- and multislice CT for assessment of mandibular condyle lesions. Dentomaxillofac Radiol 2007; 36: 24-7. https://doi.org/10.1259/dmfr/54883281
  14. Gheita T, Dahaba M, Ahmed E, Khalifa S, Basmy A. Using clinical and multislice computer tomographic features to assess temporomandibular joint osseous involvement in rheumatoid arthritis: a preliminary study. Turk J Rheumatol 2012; 27: 47-55. https://doi.org/10.5606/tjr.2012.006
  15. Alkhader M, Ohbayashi N, Tetsumura A, Nakamura S, Okochi K, Momin MA, et al. Diagnostic performance of magnetic resonance imaging for detecting osseous abnormalities of the temporomandibular joint and its correlation with cone beam computed tomography. Dentomaxillofac Radiol 2010; 39: 270-6. https://doi.org/10.1259/dmfr/25151578
  16. Voog U, Alstergren P, Eliasson S, Leibur E, Kallikorm R, Kopp S. Inflammatory mediators and radiographic changes in temporomandibular joints of patients with rheumatoid arthritis. Acta Odontol Scand 2003; 61: 57-64. https://doi.org/10.1080/ode.61.1.57.64
  17. Bayar N, Kara SA, Keles I, Koc MC, Altinok D, Orkun S. Temporomandibular joint involvement in rheumatoid arthritis: a radiological and clinical study. Cranio 2002; 20: 105-10. https://doi.org/10.1080/08869634.2002.11746198
  18. Deoghare A, Degwekar SS. Clinical and CT scan evaluation of temporomandibular joints with osteoarthritis and rheumatoid arthritis. J Indian Acad Oral Med Radiol 2010; 22 Suppl 1: 1-5. https://doi.org/10.5005/jp-journals-10011-1001
  19. Goupille P, Fouquet B, Cotty P, Goga D, Valat JP. Temporomandibular joint and rheumatoid polyarthritis: correlations between clinical and tomodensitometric abnormalities. Rev Rhum Mal Osteoartic 1992; 59: 213-8.
  20. Hajati AK, Alstergren P, Nasstrom K, Bratt J, Kopp S. Endogenous glutamate in association with inflammatory and hormonal factors modulates bone tissue resorption of the temporomandibular joint in patients with early rheumatoid arthritis. J Oral Maxillofac Surg 2009; 67: 1895-903. https://doi.org/10.1016/j.joms.2009.04.056
  21. Nomura K, Vitti M, Oliveira AS, Chaves TC, Semprini M, Siessere S, et al. Use of the Fonseca's questionnaire to assess the prevalence and severity of temporomandibular disorders in Brazilian dental undergraduates. Braz Dent J 2007; 18: 163-7. https://doi.org/10.1590/S0103-64402007000200015
  22. Sato H, Osterberg T, Ahlqwist M, Carlsson GE, Grondahl HG, Rubinstein B. Association between radiographic findings in the mandibular condyle and temporomandibular dysfunction in an elderly population. Acta Odontol Scand 1996; 54: 384-90. https://doi.org/10.3109/00016359609003556
  23. Gallagher C, Gallagher V, Whelton H, Cronin M. The normal range of mouth opening in an Irish population. J Oral Rehabil 2004; 31: 110-6. https://doi.org/10.1046/j.0305-182X.2003.01209.x
  24. Tsiklakis K. Cone beam computed tomographic findings in temporomandibular joint disorders. Alpha Omegan 2010; 103:68-78. https://doi.org/10.1016/j.aodf.2010.03.009
  25. Alexiou K, Stamatakis H, Tsiklakis K. Evaluation of the severity of temporomandibular joint osteoarthritic changes related to age using cone beam computed tomography. Dentomaxillofac Radiol 2009; 38: 141-7. https://doi.org/10.1259/dmfr/59263880
  26. Hiz O, Ediz L, Ozkan Y, Bora A. Clinical and magnetic resonance imaging findings of the temporomandibular joint in patients with rheumatoid arthritis. J Clin Med Res 2012; 4: 323-31.
  27. Helenius LM, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L, Suuronen R, et al. Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Maxillofac Surg 2006; 35: 983-9. https://doi.org/10.1016/j.ijom.2006.08.001
  28. Ozcan I, Ozcan KM, Keskin D, Bahar S, Boyacigil S, Dere H. Temporomandibular joint involvement in rheumatoid arthritis: correlation of clinical, laboratory and magnetic resonance imaging findings. B-ENT 2008; 4: 19-24.
  29. Kurup S, Gharote H, Jose R. A radiographic evaluation of temporomandibular and hand (Metacarpophalangeal)/wrist joints of patients with adult rheumatoid arthritis. Dent Res J (Isfahan) 2012; 9 (Suppl 1): S32-8.
  30. Scarfe WC, Li Z, Aboelmaaty W, Scott SA, Farman AG. Maxillofacial cone beam computed tomography: essence, elements and steps to interpretation. Aust Dent J 2012; 57 Suppl 1: 46-60. https://doi.org/10.1111/j.1834-7819.2011.01657.x
  31. Zhang ZL, Shi XQ, Ma XC, Li G. Detection accuracy of condylar defects in cone beam CT images scanned with different resolutions and units. Dentomaxillofac Radiol 2014; 43: 20130414. https://doi.org/10.1259/dmfr.20130414
  32. Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008; 37: 63-71. https://doi.org/10.1259/dmfr/16932758
  33. Audrey HX, Abd Razak HR, Andrew TH. The truth behind subchondral cysts in osteoarthritis of the knee. Open Orthop J 2014; 8: 7-10. https://doi.org/10.2174/1874325001408010007
  34. Schellhas KP, Piper MA, Omlie MR. Facial skeleton remodeling due to temporomandibular joint degeneration: an imaging study of 100 patients. Cranio 1992; 10: 248-59. https://doi.org/10.1080/08869634.1992.11677918

피인용 문헌

  1. The Roles of Indian Hedgehog Signaling in TMJ Formation vol.20, pp.24, 2018, https://doi.org/10.3390/ijms20246300
  2. Radiographic changes in TMJ in relation to serology and disease activity in RA patients vol.49, pp.1, 2018, https://doi.org/10.1259/dmfr.20190186
  3. Oral health and orofacial function in patients with rheumatoid arthritis vol.40, pp.3, 2018, https://doi.org/10.1007/s00296-019-04440-3
  4. Reliability and accuracy of segmentation of mandibular condyles from different three-dimensional imaging modalities: a systematic review vol.49, pp.5, 2018, https://doi.org/10.1259/dmfr.20190150
  5. Increased Risk of Temporomandibular Joint Disorder in Patients with Rheumatoid Arthritis: A Longitudinal Follow-Up Study vol.9, pp.9, 2020, https://doi.org/10.3390/jcm9093005
  6. Temporomandibular joint damage in K/BxN arthritic mice vol.12, pp.1, 2020, https://doi.org/10.1038/s41368-019-0072-z
  7. Radiographic changes in the temporomandibular joint related to medication in rheumatic diseases vol.50, pp.7, 2018, https://doi.org/10.1259/dmfr.20200557