Condylar and mandibular morphologic and volumetric changes in psoriatic arthritis

Background: Early initiation and optimal adjustment of aggressive therapy with disease-modifying anti-rheumatic drugs have been extremely successful in preventing irreversible joint damage. Therefore, the accurate and early diagnosis of PA and the sensitive monitoring of the disease process are essential. Advanced imaging technology capable of identifying even the slightest trace of erosive joint damage may enable the prediction of future structural and functional deterioration. Objective: The aim of this study is to show the importance of Cone Beam Computerized Tomography to volumetrically quantify TMJ damage in patients with PA, measuring condylar and mandibular real volumes. Material and Methods: 34 children with temporomandibular involvement by Psoriatic Arthritis were observed by Cone Beam Computerized Tomography. 4 were excluded because of several imaging noises. The mandible was isolated from others craniofacial structures; the whole mandibular volume and its components’ volumes (condyle, ramus, emibody, emisymphysis on right side and on left side) has been calculated by a 3D volume rendering technique. Results: The results show a highly significant statistical difference between affected side volumetric values versus normal side volumetric values above all on condyle region (P<0,01), while they doesn’t show any statistical differences between right side versus left side. Conclusion: The Cone Beam Computerized Tomography represents a huge improvement in understanding of the condyle and mandibular morphological changes, even in the early stages of the Psoriatic Arthritis. The PA can lead in children to temporomandibular joint damage with facial development and growth alterations.