Heterotopic Ossification of the Temporomandibular Joint in Juvenile Idiopathic Arthritis

2011 ◽  
Vol 38 (7) ◽  
pp. 1423-1428 ◽  
Author(s):  
SARAH RINGOLD ◽  
MAHESH THAPA ◽  
ELIZABETH A. SHAW ◽  
CAROL A. WALLACE
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Heterotopic Ossification ◽  
Temporomandibular Joint ◽  
Joint Destruction ◽  
Imaging Study ◽  
Synovial Biopsy ◽  
Radiographic Imaging ◽  
Pannus Formation ◽  
Heterotopic Ossifications ◽  
Imaging Results

Objective.To describe the clinical, laboratory, pathologic, and radiographic imaging characteristics of a series of children with juvenile idiopathic arthritis (JIA) and radiographic imaging evidence of heterotopic ossification of their temporomandibular joint (TMJ).Methods.Children were identified through search of an administrative database of imaging results at Seattle Children’s Hospital. Retrospective chart review was performed to collect data on each patient’s clinical and laboratory characteristics, systemic therapies, timing and number of TMJ intraarticular corticosteroid injections (IAS), TMJ symptoms, and TMJ findings on physician examination. TMJ imaging studies for which heterotopic ossifications were reported were reviewed. Pathology specimens were reviewed for the 2 children who underwent synovial biopsy of their TMJ.Results.Twelve children were identified. The average duration between onset of JIA and detection of heterotopic ossification of TMJ on an imaging study was 36 months (range 19–94). Half the children had abnormal mouth-opening for age when the calcifications were first detected. In each case, the heterotopic ossification was first detected by computed tomography scan, and in 11 of the cases they were associated with synovial pannus formation as documented on an imaging study. Two children underwent synovial biopsy, which revealed reactive parosteal osteochondromatosis in one case and findings consistent with an intraarticular rheumatoid nodule in the other.Conclusion.Heterotopic ossifications of the TMJ may be seen in children with JIA and are associated with particularly severe TMJ arthritis, joint destruction, and pannus formation. Pathology from these joints suggests that the heterotopic ossification may result from multiple pathological processes.

scholarly journals Differences in empathy toward patients between medical and nonmedical students: an fMRI study

2021 ◽  
Author(s):  
Shin Ah Kim ◽  
Young-Mee Lee ◽  
Stephan Hamann ◽  
Sang Hee Kim
Keyword(s):  
Medical Students ◽  
Patient Perspective ◽  
Medical Curriculum ◽  
Imaging Study ◽  
Cognitive Empathy ◽  
Functional Brain Imaging ◽  
Temporal Region ◽  
Fmri Study ◽  
Imaging Results ◽  
Increased Activity

AbstractThere is growing concern about a potential decline in empathy among medical students over time. Despite the importance of empathy toward patients in medicine, it remains unclear the nature of the changes in empathy among medical students. Thus, we systematically investigated affective and cognitive empathy for patients among medical students using neuroscientific approach. Nineteen medical students who completed their fifth-year medical curriculum and 23 age- and sex-matched nonmedical students participated in a functional magnetic resonance imaging study. Inside a brain scanner, all participants read empathy-eliciting scenarios while adopting either the patient or doctor perspective. Brain activation and self-reported ratings during the experience of empathy were obtained. Behavioral results indicated that all participants reported greater emotional negativity and empathic concern in association with the patient perspective condition than with the doctor perspective condition. Functional brain imaging results indicated that neural activity in the posterior superior temporal region implicated in goal-relevant attention reorienting was overall increased under the patient perspective than the doctor perspective condition. Relative to nonmedical students, medical students showed decreased activity in the temporoparietal region implicated in mentalizing under the patient perspective versus doctor perspective condition. Notably, this same region showed increased activity under the doctor versus patient condition in medical students relative to nonmedical students. This study is among the first to investigate the neural mechanisms of empathy among medical students and the current findings point to the cognitive empathy system as the locus of the primary brain differences associated with empathy toward patients.

scholarly journals Mandibular range of motion in children with juvenile idiopathic arthritis with and without clinically established temporomandibular joint involvement and in healthy children; a cross-sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Willemijn F. C. de Sonnaville ◽  
Caroline M. Speksnijder ◽  
Nicolaas P. A. Zuithoff ◽  
Daan R. C. Verkouteren ◽  
Nico W. Wulffraat ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Range Of Motion ◽  
Temporomandibular Joint ◽  
Cross Sectional Study ◽  
Joint Involvement ◽  
Healthy Children ◽  
Sectional Study ◽  
Cross Sectional ◽  
Explanatory Factors ◽  
Left And Right

Abstract Background Recognition of temporomandibular joint (TMJ) involvement in children with juvenile idiopathic arthritis (JIA) has gained increasing attention in the past decade. The clinical assessment of mandibular range of motion characteristics is part of the recommended variables to detect TMJ involvement in children with JIA. The aim of this study was to explore explanatory variables for mandibular range of motion outcomes in children with JIA, with and without clinically established TMJ involvement, and in healthy children. Methods This cross-sectional study included children with JIA and healthy children of age 6–18 years. Mandibular range of motion variables included active and passive maximum interincisal opening (AMIO and PMIO), protrusion, laterotrusion, dental midline shift in AMIO and in protrusion. Additionally, the TMJ screening protocol and palpation pain were assessed. Adjusted linear regression analyses of AMIO, PMIO, protrusion, and laterotrusion were performed to evaluate the explanatory factors. Two adjusted models were constructed: model 1 to compare children with JIA and healthy children, and model 2 to compare children with JIA with and without TMJ involvement. Results A total of 298 children with JIA and 169 healthy children were included. Length was an explanatory variable for the mandibular range of motion excursions. Each centimeter increase in length increased AMIO (0.14 mm), PMIO (0.14 mm), and protrusion (0.02 mm). Male gender increased AMIO by 1.35 mm. Having JIA negatively influenced AMIO (3.57 mm), PMIO (3.71 mm), and protrusion (1.03 mm) compared with healthy children, while the discrepancy between left and right laterotrusion raised 0.68 mm. Children with JIA and TMJ involvement had a 8.27 mm lower AMIO, 7.68 mm lower PMIO and 0.96 mm higher discrepancy in left and right laterotrusion compared to healthy children. Conclusion All mandibular range of motion items were restricted in children with JIA compared with healthy children. In children with JIA and TMJ involvement, AMIO, PMIO and the discrepancy between left and right laterotrusion were impaired more severely. The limitation in protrusion and laterotrusion was hardly clinically relevant. Overall, AMIO is the mandibular range of motion variable with the highest restriction (in millimeters) in children with JIA and clinically established TMJ involvement compared to healthy children.

scholarly journals Long-term Follow-up of Craniofacial Alterations in Juvenile Idiopathic Arthritis

2009 ◽  
Vol 79 (6) ◽  
pp. 1057-1062 ◽  
Author(s):  
Marinka Twilt ◽  
Alcuin J. M. Schulten ◽  
Birte Prahl-Andersen ◽  
Lisette W. A. van Suijlekom-Smit
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Temporomandibular Joint ◽  
Initial Study ◽  
Study Cohort ◽  
Craniofacial Skeleton ◽  
Lateral Cephalograms ◽  
Long Term Follow Up ◽  
Angular Measurements

Abstract Objective: To investigate changes in the craniofacial skeleton in relation to the changes in condylar alterations that occur during long-term follow-up in patients with juvenile idiopathic arthritis. Materials and Methods: Temporomandibular joint (TMJ) involvement is defined as a condylar alteration that is observed on the orthopantomogram. Lateral cephalograms were used to determine linear and angular measurements. Results: Seventy of 97 patients from the initial study cohort were included, with a mean follow-up of 68 months. The overall prevalence of condylar alterations and posterior rotation of the mandible decreased; however, the prevalence of retrognathia remained the same. Patients showed improvement in the degree of retrognathia and posterior rotation (40% ANB, 51% OP-SN, and 44% GO-GN-SN). Improvement in the degree of retrognathia was seen more often in patients with improved condylar alterations than in patients with persistent alterations and in those without alterations (50%, 33%, and 28%, respectively). The degree of posterior rotation improved almost equally in patients without TMJ involvement and in patients with improved condylar alterations (57% and 50% by OP-SN, and 67% and 38% GO-GN-SN, respectively) and did not improve in patients with stable persistent alterations. Conclusion: Both condylar and craniofacial alterations can improve in patients with juvenile idiopathic arthritis.

Temporomandibular Joint Involvement in Children with Juvenile Idiopathic Arthritis

2010 ◽  
Vol 38 (3) ◽  
pp. 510-515 ◽  
Author(s):  
ELVIRA CANNIZZARO ◽  
SILKE SCHROEDER ◽  
LUKAS M. MÜLLER ◽  
CHRISTIAN J. KELLENBERGER ◽  
ROTRAUD K. SAURENMANN
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Temporomandibular Joint ◽  
Upper Extremity ◽  
Age At Onset ◽  
Disease Onset ◽  
Joint Involvement ◽  
Hla B27 ◽  
Radiological Findings ◽  
Rheumatology Clinic ◽  
Younger Age

Objective.To determine the rate of temporomandibular joint (TMJ) involvement and find factors associated with TMJ arthritis in a single-center cohort of patients with juvenile idiopathic arthritis (JIA).Methods.Retrospective analysis of all patients with JIA visiting the rheumatology clinic between January 1, 2005, and December 31, 2006. Followup information was included until August 2008. A diagnosis of TMJ arthritis was based on clinical rheumatological and/or radiological findings.Results.After a mean followup time for JIA of 4.6 years (range 0.08–14.17), 86/223 patients (38.6%) had developed TMJ arthritis. The rate of TMJ involvement differed significantly among JIA subtypes (p = 0.0016), with 61% in extended oligoarticular, 52% in polyarticular rheumatoid factor (RF)-negative, 50% in psoriatic, 36% in systemic, 33% in polyarticular RF-positive, 33% in persistent oligoarticular, 30% in unclassified JIA, and 11% in enthesitis-related arthritis. The rate of TMJ involvement in our cohort was statistically significantly lower for patients who were HLA-B27-positive (p = 0.0002). In a multivariate analysis, the association of the following factors was confirmed: JIA subtype (p = 0.0001), a higher erythrocyte sedimentation rate (ESR) at diagnosis (p = 0.0038), involvement of joints of the upper extremity (p = 0.011), the absence of HLA-B27 (p = 0.023), and younger age at onset of JIA (p = 0.050).Conclusion.In our cohort of children with JIA, the overall rate of TMJ involvement was 38.6%. Patients with certain JIA subtypes, a higher ESR at disease onset, involvement of upper extremity joints, and younger age at diagnosis were more likely to develop TMJ arthritis. The presence of HLA-B27 seemed to be protective.

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