Ultrasound imaging in Juvenile Idiopathic Arthritis: Diagnostic and monitoring use of the ultrasonography on the temporomandibular joints

Aim: In Department of Orthodontics together with Pediatric Department is now active the service of Ultrasonography service for the assessment of the temporomandibular joints (TMJ) I patients with Juvenile Idiopathic Arthritis (JIA). The aim of this study is to show that the ultrasonography is a useful tool to identify and to register the evolution of the pathologic alterations of the temporomandibular joints in 150 pediatric patients with Juvenile Idiopathic Arthritis. Methods: The sonography became a basic diagnostic exam to make in all pediatric patients with Juvenile Idiopathic Arthritis (JIA) to evaluate condyles and condylar movements. Since 2013 we have been analyzed more than 150 patients with Juvenile Idiopathic Arthritis Every single patient was subjected to periodic assessment to confirm the therapeutic efficiency of orthodontic device. All patients have been subjected to a clinical intraoral and extraoral exam to the function evaluation of the temporomandibular joints (TMJ). Ultrasonography has been applied using a standard technique, patient lied position, on a platform type GE model Logic E9®, with transducer from 11 to 18 MHz that changes according to the age of the patient. In some analyzed cases was noticed: irregularities of the condyle, capsular thickness, (effusion-synovial thickness) Vascular signal was increased, disk dislocation, vascular increase trough color Doppler and condylar symmetries with open and closed mouth. Results: In the 42% of the cases the condyle function was regular on the opening in both sides. Irregularities of the bony surface were found in 51 % of the cases, and Irregularities of thickness in 37% of the cases. A transition asymmetry from the position of open mouth to a close mouth was founded in 18 patients, and in 5 patient it was not possible to be evaluated. Conclusion: The sonography, just unlike the magnetic resonance which is the gold standard where the pediatric patients should be immobile for 30 minutes, is a helpful screening method to identify the alterations of the condyles in pediatric patients with Juvenile Idiopathic Arthritis (JIA) even if it does not allow to get a full three dimensional vision of the bony structure. The very young patients can tolerate the sonography test, the patient is not obliged to stay immobile, it also has no biological cost so it is can be repeated easily. In conclusion, Sonography can be considered an acceptable diagnostic test by young patients to get an early diagnosis, it can also be used to monitor the growth of the patient.