JIA and ultrasound: evaluation of sample

Aim: The purpose of this work is the evaluation of the effectiveness of the ultrasound examination for early diagnosis of pathological changes of temporomandibular joint. We analyzed the information obtained by ultrasound examinations in a sample of pediatric patients with juvenile rheumatoid arthritis. In this study we included 65 patients with juvenile idiopathic arthritis: 10 males and 55 females aged between 1 and 23 years with a mean age of 12.8 years and median of 13.1. The course of the disease from the diagnosis of JIA is between 0 and 20 years with a mean of 7.9 and median of 6.5. All patients were clinically examined: clinical examination included analysis of the face, intraoral examination and functional exam of temporomandibular joint. Methods: All patients were subjected to ultrasound examination, with standardized technique, by 1 single operator. The operator who performed the ultrasound examinations is a doctor with a specialization in Radiology of the Radiology Unit - Pediatric Division Fondazione IRCCS Ca' Granda General Hospital. Ultrasound examination was carried out with standardized technique with the patient lying down. At least 2-3 oblique and axial scans were performed for each ATM right and left, having the articular bone heads as reference, in particular the mandibular condyle. The patients were examined with all the same equipment of ultrasound platform (branded GE model Logic E9) and high-frequency linear array transducer (12 to 18 MHz depending on the age of the patient). Results: By Ultrasound examinations carried out, the interpretation of ultrasound images and the reading of the reports, we can summarize the following data. Analyzed the case histories of 70 ultrasound evaluations: 11 instrumental testing proves negative to any pathological changes (0 reports altered) (16° of the total); with an average age of 8.5 years (range 3-19.5) and with a mean of 4.7 years after the onset of AIG (range 0-10.5) - 21 instrumental tests show bilateral alterations (30%); - 31 instrument tests unilateral alterations; - 7 instrumental tests show abnormalities not to the condylar structure. A balance between changes of condylar profile on the right and left sides can be observed: 36 and 3 respectively. (51%, 53%). Conclusion: Thanks to the analysis of the data, we can say that US examination can be considered a tool for diagnosing condylar structure's alterations, especially in patients with AIG, despite it does not allow three-dimensional visualization of the whole structure. It is emphasized at the same time that ultrasounds represent easily repeatable tests without biological costs. lt is also important to underline that the ultrasound examination is well-accepted by the patient and its parents as a diagnostic test. We conclude supporting the importance of as early as possible diagnosis in Orthodontics for all the patients particularly in patients with arthritis. Therefore we consider interesting in the future to keep an indication of ultrasounds as toll for study initial TMJ involvement: above all, we suggest US exams in small patients who increasingly are presenting at our Dental Clinic directed by the Hospital or other center.