Magnetic resonance imaging of temporomandibular joint in juvenile idiopathic arthritis

Namrita Sachdev, Yashvant Singh, Parikha Rampal, Sana .


Background: Juvenile Idiopathic Arthritis (JIA) is the most common autoimmune inflammatory synovial arthritis causing wide range of disability in children. The involvement of temporo-mandibular joint (TMJ) in JIA varies ranging from 17% to 87%. Unlike other synovial joints, the TM joint is particularly vulnerable to inflammatory damage as the mandibular growth plate is superficial. JIA is a clinical diagnosis and is characterized by synovial hyperplasia and inflammation leading to joint effusion. TMJ involvement is clinically difficult to assess and often goes untreated. Children with TMJ arthritis have mastication dysfunction and pain. Delayed detection and treatment leads to abnormalities like micrognathia, jaw deformity, facial dysmorphism and chewing problems. MRI is the most sensitive modality to diagnose synovitis and involvement of TMJ in children of JIA.

Methods: A cross-sectional observational study was undertaken in 30 children diagnosed as JIA as per ILAE criteria. They were evaluated clinically followed by contrast enhanced MRI for evidence of TMJ arthritis.

Results: Of the 60 joints evaluated, clinical involvement was found in 18 joints (10 patients). 12(66.7%) out of them had MRI changes. 3(7.1%) joints out of 42 asymptomatic joints had MRI changes. 13 joints had synovial hypertrophy, 8 joints showed bone erosions. Bone marrow edema was seen in 2 joints, with no evidence of cartilage involvement in any joint. The sensitivity, specificity, PPV and NPV of clinical examination to diagnose TMJ arthritis as compared to MRI was 80.0%, 86.7%, 66.7% and 92.7% respectively.

Conclusions: With paucity of clinical signs and symptoms, early involvement of TMJ arthritis in children of JIA can be detected by MRI to prevent long term disability in patients.


Arthritis, Juvenile Idiopathic Arthritis, Magnetic Resonance Imaging, Synovitis, Temporomandibular

Full Text:



Cassidy JT and Petty RE. Chronic arthritis in children. In: JT Cassidi, Petty RE, Laxer RM, Lindley CB, eds. Text Book of Pediatric Rheumatology. 6th ed. Elsevier Saunder; 2011: 211-234.

Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Juvenile Idiopathic Arthritis. Nelson Textbook of Pediatrics. In: Kliegman, Stanton, St Geme, Schor. First South Asian edition. Elsevier Health Sciences; 2015;21(55): 1160-1170.

Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004 Feb;31(2):390.

Kulas DT, Schanberg L. Juvenile idiopathic arthritis. Curr Opinion Rheumatol. 2001 Sep 1;13(5):392-8.

Arabshahi B, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis: the forgotten joint. Curr Opinion Rheumatol. 2006 Sep 1;18(5):490-5.

Twilt M, Mobers SM, Arends LR, ten Cate R, van Suijlekom-Smit L. Temporomandibular involvement in juvenile idiopathic arthritis. J Rheumatol. 2004 Jul 1;31(7):1418-22.

Navallas M, Inarejos EJ, Iglesias E, Cho Lee GY, Rodríguez N, Antón J. MR imaging of the temporomandibular joint in juvenile idiopathic arthritis: technique and findings. Radiographics. 2017 Mar;37(2):595-612.

Niibo P, Pruunsild C, Voog-Oras Ü, Nikopensius T, Jagomägi T, Saag M. Contemporary management of TMJ involvement in JIA patients and its orofacial consequences. EPMA J. 2016 Dec 1;7(1):12.

Fjeld MG, Arvidsson LZ, Stabrun AE, Birkeland K, Larheim TA, Øgaard B. Average craniofacial development from 6 to 35 years of age in a mixed group of patients with juvenile idiopathic arthritis. Acta Odontol Scandinav. 2009 Jan 1;67(3):153-60.

Stoustrup P, Koos B. Clinical craniofacial examination of patients with juvenile idiopathic arthritis. Semin Orthod. 2015;21(2):94-101

Keller H, Müller LM, Markic G, Schraner T, Kellenberger CJ, Saurenmann RK. Is early TMJ involvement in children with juvenile idiopathic arthritis clinically detectable? Clinical examination of the TMJ in comparison with contrast enhanced MRI in patients with juvenile idiopathic arthritis. Pediatric Rheumatology. 2015 Dec;13(1):56.

Weiss PF, Arabshahi B, Johnson A, Bilaniuk LT, Zarnow D, Cahill AM, et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arth Rheumat. 2008 Apr;58(4):1189-96.

Farronato G, Garagiola U, Carletti V, Cressoni P, Mercatali L, Farronato D. Change in condylar and mandibular morphology in juvenile idiopathic arthritis: cone beam volumetric imaging. Minerva Stomatol. 2010 Oct;59(10):519-34.

Hauser RA, Schroeder S, Cannizzaro E, Muller L, Kellenberger CJ, Saurenmann RK. How important is early magnetic resonance imaging of the temporomandibular joint for the treatment of children with juvenile idiopathic arthritis: a retrospective analysis. Pediatr Rheumatol. 2014 Dec 1;12(1):36.

Vaid YN, Dunnavant FD, Royal SA, Beukelman T, Stoll ML, Cron RQ. Imaging of the temporomandibular joint in juvenile idiopathic arthritis. Arthr Care Res. 2014 Jan;66(1):47-54.

Cannizzaro E, Schroeder S, Müller LM, Kellenberger CJ, Saurenmann RK. Temporomandibular joint involvement in children with juvenile idiopathic arthritis. J Rheumatol. 2011 Mar 1;38(3):510-5.