Mandibular changes in Psoriatic Arthritis : 3D volumetric study with Cone Beam Computerized Tomography

Introduction 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 Psoriatic Arthritis (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. Objectives The purpose of this study is to demonstrate the importance of Cone Beam Computerized Tomography (CBCT) to evaluate the articular damage in patients with PA, through volumetric measurement of the mandibular condyle and the mandible with proportion 1:1. Materials and Methods 53 patients affected by articular PA were subjected to CBCT. The mandible was isolated from the other structures and it was segmented in various components (condyle, ramus, emibody and emisymphysis) on both left and right hand side. The obtained volumes were estimated with the use of dedicated software. Results The results show statistically a very significant difference between affected condyles and healthy ones in patients with unilateral PA (p<0.001), the difference between the volumes of the ramus of the affected side and those of the ramus of the healthy side is statistically significant (p=0.09); there is no significance in the comparison between the volumes in the control group of healthy patients. Conclusions The articular damage causes a deficit in the development of the condyle and of the mandibular ramus, because the growth of such structures depends on the condylar cartilage, while the body and emisymphysis grow in a different way. The CBCT is an instrument that helps diagnosing the articular damage, even in the most premature phases of the disease.