Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis and Other Pediatric Rheumatic Diseases
Session Type: Abstract Submissions (ACR)
Background/Purpose: Detection of involvement of temporomandibular joints (TMJ), which are frequently affected by juvenile idiopathic arthritis (JIA), is only possible on Gadolinium enhanced MRI (GdMRI). A comparative X-ray study on adults with JIA and RA showed a more frequent involvement and destruction of the dens axis in JIA patients. The aim of the retrospective study was to evaluate the involvement of the cervical spine (CS) in children with JIA.
Methods: The first GdMRI TMJ examinations of consecutive patients with defined JIA from our center were re-evaluated for involvement of the cervical spine (dens axis, DA). Clinical parameters were recorded – CS pain on motion, CS limited range of motion (LOM), peripheral disease activity (PDA, peripheral active, painful and LOM joints) and medication. MRI examinations were re-evaluated for TMJ and dens axis arthritis defined as synovitis and synovial hypertrophy.
Results: 40 children (29 female) were included. 21 patients had RF neg. polyarthritis, oligoarthritis was present in 11, ERA and PsA in 4 children equally. Median age at GdMRI was 14 (7-18) years. Median disease duration was 36 (4-192) months. At first GdMRI 47% were on NSAIDs with a median duration of 10 (1-36) months, 49% were on MTX (sc 10-15 mg/m2) with a median duration of 12 months and 13 patients were on TNF Alpha inhibitors with a median duration of 3 (2-12) months. 10 patients showed no PDA but of these only one had no inflammation in DA and TMJ on GdMRI. 34 patients had arthritis in DA (25) or TMJ (33) and 25 patients had arthritis in both DA and TMJ. Out of all patients only 8 had pain and/or LOM of the CS, which were always correlated with arthritis in TMJ and DA on GdMRI. In all other patients CS involvement was silent. Current medication was not able to control disease activity.
Conclusion: considering that long-term sequels of CS arthritis in adults with JIA tend to be more severe than in RA patients, the high frequency of silent CS arthritis should be kept in mind, where GdMRI is the only tool to detect the extent of disease activity of the cervical spine and help with a proper monitoring of the treatment effect.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-prevalence-of-cervical-spine-and-temporomandibular-joint-involvement-in-patients-with-juvenile-idiopathic-arthritis/