Arabshahi Bita, Cron Randy Q
Division of Rheumatology, Children's Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA.
Curr Opin Rheumatol. 2006 Sep;18(5):490-5. doi: 10.1097/01.bor.0000240360.24465.4c.
This review explores the prevalence, clinical and radiographic signs, and treatment of temporomandibular joint arthritis in children with juvenile idiopathic arthritis.
Temporomandibular joint arthritis seems to be a more frequent manifestation in patients with juvenile idiopathic arthritis than previously believed, in part due to the paucity of clinical symptoms and poor sensitivity of conventional radiographs used for diagnosis. Antinuclear antibody positivity, early onset of disease, and presence of systemic or polyarticular disease are all risk factors for temporomandibular joint arthritis but may underpredict temporomandibular joint involvement in juvenile idiopathic arthritis. Magnetic resonance imaging enhanced with gadolinium is currently the gold standard in detection of temporomandibular joint arthritis, and treatment with intra-articular corticosteroids has been shown to be effective and safe, with minimal side effects.
Given the paucity of clinical symptoms in temporomandibular joint arthritis, detection of temporomandibular joint inflammation using contrast-enhanced magnetic resonance imaging is essential for instituting appropriate therapy in a timely fashion. The use of intra-articular corticosteroids holds promise for control of temporomandibular joint inflammation and prevention of associated morbidities.
本综述探讨幼年特发性关节炎患儿颞下颌关节关节炎的患病率、临床及影像学表现和治疗方法。
颞下颌关节关节炎在幼年特发性关节炎患者中似乎比以往认为的更为常见，部分原因是临床症状较少以及用于诊断的传统X线片敏感性较差。抗核抗体阳性、疾病早期发作以及存在全身或多关节疾病均为颞下颌关节关节炎的危险因素，但可能会低估幼年特发性关节炎患者的颞下颌关节受累情况。钆增强磁共振成像目前是检测颞下颌关节关节炎的金标准，关节内注射皮质类固醇治疗已被证明有效且安全，副作用极小。
鉴于颞下颌关节关节炎临床症状较少，使用对比增强磁共振成像检测颞下颌关节炎症对于及时进行适当治疗至关重要。关节内注射皮质类固醇有望控制颞下颌关节炎症并预防相关并发症。
