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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.
Congress: ECR 2018
Poster No.: C-0415
Type: Scientific Exhibit
Keywords: Arthritides, Imaging sequences, MR, Musculoskeletal system, Musculoskeletal joint
Authors: G. Posillico1, P. Trovato1, F. rosella2, I. Simonetti3, M. Iodice1, P. P. Saturnino4, P. Liguori4, L. Manfredonia1, T. Pirronti5; 1Caserta/IT, 2Roma/IT, 3Napoli/IT, 4Caserta, Italy/IT, 5Roma (RM)/IT


MR alterations of the TMJ: The evalutation of the TMJ showed (figure 1): 20 PT with erosions of the condyle (figures 2, 3): 12 unilaterally (Long RA) and 8 bilaterally (Long RA); 24 PT with thinning of the disk (figure 4): 12 unilaterally (Long RA) and 12 bilaterally (Long RA); 32 PT with a flattening of the condyle (figure 4): 20 unilaterally (12 Long RA and 8 Early RA) and 12 bilaterally (Long RA); 4 PT with joint effusion (Long RA); 12 PT with condylar bone edema: 8 unilaterally (Long RA) and 4 bilaterally (Early RA); 12 PT with monolateral reducible anterior dislocation (8 Long RA and 4 Early RA); 16 PT with non-reducible anterior dislocation (figure 4): 12 unilaterally (8 Long RA and 4 Early RA) and 4 bilaterally (Long RA); No PT with evidence of fracture of the disc or synovial pannus.

MR alterations of the AAJ: The evaluation of the AAJ by out method showed (Figure 5): 8 PT with synovial pannus (Long RA); 4 PT with erosions (Long RA), 4 PT with subluxation (figures 6, 7), belonging to the Long RA group; No PT with joint effusion, bone edema, dislocation, alar ligament rupture and medullary compression. Of the 56 patients with TMJ symptomatology (40 Long RA and 16 Early RA), in 8 patients (14%, 4 Long RA and 4 Early RA) no alterations of the joint were found with our method. The remaining patients (48, 86%) showed the following alterations: erosions (16 PT, 33%), thinning of the disc: (16 PT, 33%), bone edema (12 PT, 25%), flattening of the condyle (28 PT, 58%), reducible dislocation (12 PT, 25%), irreducible dislocation (16 PT, 33%). They were symptomatic: 80% of the patients with erosions, 65% of the patients with thinning of the disk, 100% of the patients with bone edema, 87% of the patients with flattening of the condyle, 100% of the patients with dislocation (reducible and/or irreducible). 52 patients presented cervical pain and/or morning stiffness: only 2 patients (15%), belonging of the Long RA group, had synovial pannus (1 associated with subluxation and 1 associated with erosions).

Statistical correlations: Significantly correlated correlations were observed (Chi-square test and Fischer's exact test) between the alterations of the TMJ and the Long RA: between the autoantibody positivity and flattening the disk (p=0.018); between the positivity of acute phase reactants of inflammation and condylar bone edema (p = 0.018) and irreducible disk dislocation (p = 0.018).


The flattening of the disk is associated with TMJ symptomatology (p=0.043); the inflammation indices seem to be correlated, at the limits of statistical significance (p=0.057), with the anterior dislocation; TMJ symptomatology seems to be correlated, to the limits of statistical significance, with the reducible dislocation (p 0.057); the long AR is associated with condylar edema at the limits of statistical significance (p=0.06). No correlations between Early RA and organic changes of the two joints were found.

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