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Tarsia M, Zajc Avramovič M, Gazikalović A, Ključevšek D, Avčin T. A clinical perspective on imaging in juvenile idiopathic arthritis. Pediatr Radiol 2024; 54:490-504. [PMID: 38015293 PMCID: PMC10984900 DOI: 10.1007/s00247-023-05815-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with juvenile idiopathic arthritis (JIA). Over the past few decades, great efforts have been made to improve the quality of diagnostic imaging and to reach a consensus on which methods and scoring systems to use. However, there are still some critical issues, and the diagnosis, course, and management of JIA are closely related to clinical assessment. This review discusses the main indications for conventional radiography (XR), musculoskeletal ultrasound (US), and magnetic resonance imaging (MRI), while trying to maintain a clinical perspective. The diagnostic-therapeutic timing at which one or the other method should be used, depending on the disease/patient phenotype, will be assessed, considering the main advantages and disadvantages of each imaging modality according to the currently available literature. Some brief clinical case scenarios on the most frequently and severely involved joints in JIA are also presented.
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Affiliation(s)
- Maria Tarsia
- Clinical Paediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Mojca Zajc Avramovič
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20 SI-1525, 1000, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ana Gazikalović
- Department of Radiology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000, Ljubljana, Slovenia
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva ulica 20, 1000, Ljubljana, Slovenia
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Bohoričeva 20 SI-1525, 1000, Ljubljana, Slovenia.
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Januzzi E, Cunha TCA, Silva G, Souza BDM, Duarte ASB, Zanini MRS, Andrade AM, Pedrosa AR, Custódio ALN, Castro MAA. Viscosupplementation in the upper and lower compartments of the temporomandibular joint checked by ultrasonography in an ex vivo and in vivo study. Sci Rep 2022; 12:17976. [PMID: 36289252 PMCID: PMC9606122 DOI: 10.1038/s41598-022-21781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Viscosupplementation (VS) of the temporomandibular joint (TMJ) aims to treat temporomandibular dysfunction (TMD) by stimulating synovial cells to improve intracapsular lubrication. The purpose of the present study was to assess a VS protocol planned with the aid of cone-beam computed tomography (CBCT) and checked by ultrasonography (US). The study was carried out in 3 stages. The first was to check the correspondence between the proposed facial reference points and the osseous components of the joint by means of CBCT. In the second stage, the upper and lower compartments of 20 TMJs of fresh frozen cadavers were injected with coloured liquids, and the accuracy of the technique was confirmed by dissecting the anatomical specimens. The third stage consisted of VS in 10 patients (20 TMJs), with real-time verification of the location of the needle tip by means of ultrasonography. CBCT confirmed the correct locations of the marked points used in the proposed VS protocol. The dissections showed that 13 of the 14 injections effectively reached the upper and lower compartments. The location of the needle tip was effectively verified by ultrasonography, confirming the correct access to both compartments. The proposed protocol was effective for accessing the upper and lower compartments of the TMJ. The evaluated protocol proved to be accurate, safe and clinically reproducible means of VS in the upper and lower compartments of the TMJ.
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Affiliation(s)
- Eduardo Januzzi
- grid.414826.d0000 0004 0496 9134Orofacial Pain Center of the Mater Dei Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | | | | | | | - Antônio Luís Neto Custódio
- grid.8430.f0000 0001 2181 4888Biological Sciences Institute of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Maurício Augusto Aquino Castro
- grid.8430.f0000 0001 2181 4888Department of Dental Clinics, Oral Pathology and Oral Surgery of the Faculty of Dentistry of the Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais CEP: 31.270-901 Brazil
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Bilgir E, Yıldırım D, Șenturk MF, Orhan H. Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis. Cranio 2020:1-10. [PMID: 33267750 DOI: 10.1080/08869634.2020.1853889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach.Methods: Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up.Results: Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises.Conclusion: Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.
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Affiliation(s)
- Elif Bilgir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Derya Yıldırım
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Fatih Șenturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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Cha Y, O J, Park JK, Yang HM, Kim S. Ultrasound-guided versus blind temporomandibular joint injections: a pilot cadaveric evaluation. Int J Oral Maxillofac Surg 2019; 48:540-545. [DOI: 10.1016/j.ijom.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 11/27/2022]
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Champs B, Corre P, Hamel A, Laffite C, Le Goff B. US-guided temporomandibular joint injection: Validation of an in-plane longitudinal approach. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:67-70. [DOI: 10.1016/j.jormas.2018.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/21/2018] [Indexed: 11/30/2022]
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Resnick CM, Vakilian PM, Kaban LB, Peacock ZS. Is Intra-Articular Steroid Injection to the Temporomandibular Joint for Juvenile Idiopathic Arthritis More Effective and Efficient When Performed With Image Guidance? J Oral Maxillofac Surg 2016; 75:694-700. [PMID: 28718441 DOI: 10.1016/j.joms.2016.09.045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/19/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS This is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital (Boston, MA). Patients were divided into groups according to IASI technique: 1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance or 2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs image guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER), and total procedure time. RESULTS Forty-five patients with 71 injected TMJs were included. Twenty-two patients with 36 injected TMJs were in the landmark group and 23 patients with 35 injected joints were in the image-guided group. There were no relevant differences in age, gender, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (P = 1.00), increase in MIO (P = .975), or decrease in ER (P = .492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (P < .008). CONCLUSIONS There were no statistical differences in short-term outcomes, but procedure times were longer for the image-guided group. Although specific indications for the use of image guidance might exist, routine use of this procedure cannot be justified.
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Affiliation(s)
- Cory M Resnick
- Attending Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital; Instructor, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA.
| | - Pouya M Vakilian
- DMD Candidate, Harvard School of Dental Medicine; Research Assistant, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Leonard B Kaban
- Attending Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Walter C. Guralnick Distinguished Professor, Harvard School of Dental Medicine, Boston, MA
| | - Zachary S Peacock
- Attending Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Assistant Professor, Harvard School of Dental Medicine, Boston, MA
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Sivri MB, Ozkan Y, Pekiner FN, Gocmen G. Comparison of ultrasound-guided and conventional arthrocentesis of the temporomandibular joint. Br J Oral Maxillofac Surg 2016; 54:677-81. [DOI: 10.1016/j.bjoms.2016.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Abstract
BACKGROUND In the recent years, musculoskeletal ultrasound (MSUS) has been regarded as especially promising in the assessment of juvenile idiopathic arthritis (JIA), as a reliable method to precisely document and monitor the synovial inflammation process. MAIN CONTENT MSUS is particularly suited for examination of joints in children due to several advantages over other imaging modalities. Some challenges should be considered for correct interpretation of MSUS findings in children, due to the peculiar features of the growing skeleton. MSUS in JIA is considered particularly useful for its ability to detect subclinical synovitis, to improve the classification of patients in JIA subtypes, for the definition of remission, as guidance to intraarticular corticosteroid injections and for capturing early articular damage. Current evidence and applications of MSUS in JIA are documented by several authors. Recent advances and insights into further investigations on MSUS in healthy children and in JIA patients are presented and discussed in the present review. CONCLUSIONS MSUS shows great promise in the assessment and management of children with JIA. Nonetheless, anatomical knowledge of sonographic changes over time, underlying immunopathophysiology, standardization and validation of MSUS in healthy children and in patients with JIA are still under investigation. Further research and educational efforts are required for expanding this imaging modality to more clinicians in their daily practice.
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Affiliation(s)
- Silvia Magni-Manzoni
- Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
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