Imaging Sci Dent.  2018 Mar;48(1):1-9. 10.5624/isd.2018.48.1.1.

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

• Rehan OM
• Saleh HA
• Raffat HA
• Abu-Taleb

• KMID: 2406977
• DOI: http://doi.org/10.5624/isd.2018.48.1.1

Abstract

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.

Keyword

Arthritis, Rheumatoid; Cone-Beam Computed Tomography; Temporomandibular Joint

MeSH Terms

Arthritis, Rheumatoid*
Blood Sedimentation
Bone Cysts
Cone-Beam Computed Tomography*
Diagnosis
Humans
Osteophyte
Prevalence
Rheumatoid Factor
Sclerosis
Temporomandibular Joint*
Rheumatoid Factor

Figure

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  Fig. 1 A bar chart demonstrates the proportions of rheumatoid arthritis (RA) patients showing various temporomandibular joint clinical findings.

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  Fig. 2 Corrected and reformatted sagittal cone-beam computed tomographic images of rheumatoid arthritis patients revealing erosion as the loss of cortical continuity (arrow).

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  Fig. 3 Reformatted cone-beam computed tomographic images of a rheumatoid arthritis patient showing flattening of the condyle. A. Corrected sagittal view reveals flattening of the superior surface of the condyle (arrow). B. Corrected coronal view shows flattening of the medial part of the same condyle (arrow).

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  Fig. 4 Corrected sagittal cone-beam computed tomographic images of a rheumatoid arthritis patient showing an osteophyte (arrow).

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  Fig. 5 Corrected sagittal cone-beam computed tomographic images of a rheumatoid arthritis patient showing condylar deformity. Note the presence of sclerosis and osteophyte formation.

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  Fig. 6 Corrected reformatted conebeam computed tomographic images of a rheumatoid arthritis patient showing subchondral cysts (arrows). A. Corrected sagittal view. B. Corrected coronal view. Note the extensive subchondral sclerosis depicted in the coronal view.

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  Fig. 7 Corrected coronal cone-beam computed tomographic images of a rheumatoid arthritis patient showing surface irregularities in the superior aspect of the condyle. Note the extensive sclerosis and subchondral cysts.

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  Fig. 8 Reformatted cone-beam computed tomographic images of a rheumatoid arthritis patient. A. Corrected coronal view. B. Axial view. C. Corrected sagittal view shows surface irregularities of the condyle and extensive sclerosis.

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