|ECR 2018 / C-0415|
|Evaluation of temporomandibular (tmj) and atlanto-axial (aaj) joints with open gantry low field mr without contrast in patients with early and long rheumatoid arthritis.|
Methods and materials
Patient population: Eighty adult patients (mean age=55.65 years, 64 females and 16 males) were enrolled with RA diagnosis according to the criteria ACR/EULAR 2010  and were divided into 2 groups: Early group (RA with onset <1 year) consisting of 32 patients, diagnosed between 2 months and 1 year (average: 9.75 months) and Long Group (RA with onset> 1 year) consisting of 48 patients, diagnosed between 2 years and 49 years (average: 13 years).
In both groups we evaluated the autoantibodies typical of RA, ACPAs (anti-peptide citrullinated antibodies), RF (rheumatoid factor) and ANAs (anti-nucleus antibodies) [17,18], ESR (sedimentation rate of erythrocytes) and CRP (C-reactive protein). We evaluated the presence of TMJ symptomatology correlated to the articular involvement in the course of RA (TMJ pain, mandibular block, functional limitation, morning stiffness, joint click, signs of inflammation) , the presence of cervical symptomatology correlated to RA (cervical pain, morning stiffness, signs of inflammation) and the presence of RA manifestations of other joints (wrist and/or hand and/or elbow and/or foot and/or ankle and/or knee and/or shoulder and/or pelvic girdle uni/bilaterally). Furthermore, we considered extra-articular manifestations of AR and the type of therapy in place, if exclusively conventional therapy or even biological therapy [20, 21].
Data acquision: The radiological evaluation of the alterations of the TMJ and the AAJ was done by open gantry low field (0.28T) MRI without contrast (Esaote S-Scan) . For the temporomandibular joint examination, the TMJ coil 15 (acquisition field with a length of about 200mm and a width of about 110mm) was used, provided with six pairs of connectors and a central hole which allows the correct centering of the region to be analyzed; we used sequences: Proton Density (PD) in opening and closing , Fast Spin Echo (FSE) T2 in closing (all the sequences were acquired on the sagittal and oblique planes). The TMJ findings considered were: erosion of the condylar profile, thinning of the articular disk, joint effusion, bone edema, flattening of the condyle, reducible and/or irreducible dislocation, the fracture of the disk, the presence of synovial pannus. For the AAJ examination, a specific linear coil was used (acquisition field with a length of about 200mm along the spine and a width of about 110mm) with six pairs of connectors inside it; we used sequences: sagittal Spin Echo (SE) T1 and FSE T2, coronal SE T1, FSE T2 and Short Tau Inversion Recovery (STIR), axial X-Bone and 3D HYCE . The AAJ findings considered were: the presence of synovial pannus, erosions, joint effusion, bone edema, subluxation, dislocation, rupture of the alar ligaments, medullary compression.
Statistical Analysis: Data were analyzed by multivariate analysis using 2 x 2 contingency tables, SPSS 10 (IBM Statistics). All the parameters considered in the study were considered as "non-parametric values", comparing the parameters of radiological relevance with the parameters of clinical and laboratory relevance.
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