505: Magnetic Resonance Imaging Findings in Temoromandibular Joint and Juvenile Idiopathic Arthritis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary orofacial pain, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Juvenile idiopathic arthritis (JIA) frequently involves the temporomandibular joint (TMJ), causing pain, cartilage and bone destruction, and disturbed mandibular growth. Early disease may lack pain despite active TMJ inflammation, making diagnosis difficult. Despite biologic therapies, progression of orofacial symptoms and MRI-detected TMJ inflammation remains poorly understood. Distinguishing true inflammation from normal skeletal immaturity on TMJ MRI is challenging, minor joint fluid or contrast enhancement without chronic changes should not confirm arthritis, whereas chronic changes are characteristic. Long-term studies show persistent consequences of TMJ Involvement.

The aim of this study was to evaluate longitudinal intra-articular changes in the TMJ in JIA.

Methods: A two-year prospective study included 40 JIA patients: 18 (45%) with oligoarthritis, 13 (33%) with polyarthritis, and 9 (22%) with other subtypes. At baseline, 11 (27%) received biologics, increasing to 14 (35%) at two years; combination biologics + DMARDs was used by 5 at baseline and 6 (15%) at follow-up. Median age was 12 years at baseline and 14 years at two years. The JIA patients underwent MR imaging of the TMJs at baseline and at 2-year follow up. TMJ MRI assessed inflammatory changes (bone marrow edema, joint effusion, synovial thickening) and damage (condylar flattening, erosion), evaluating longitudinal intra-articular progression.

Results: At baseline, 69% of the TMJs had no inflammatory signs. At two-year follow-up 54% remained free of inflammation, while 29% of those without initial signs had developed inflammation. At baseline, 31% of the TMJs had inflammatory signs. At the two-year follow-up, 40% had inflammatory signs, while 20% exhibited more pronounced inflammatory signs. At baseline in the damage domain, 54% of the TMJs showed no damage, while 46% exhibited damage. At the two-year follow-up, 41% remained without damage, 42% had damage signs, and 16% showed more pronounced damage signs.

Conclusions: Only minor changes in magnetic resonance imaging inflammatory and damage findings in the temporomandibular joint was observed over two years in patients with juvenile idiopathic arthritis.

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Presenting Author: Alexandra Dimitrijevic Carlsson
Submitting Author: Alexandra Dimitrijevic Carlsson

Senior Author: Per Alstergren

IASP 2026 Global Year theme of Neuropathic Pain: No

• Eva Klintström: PhD - Department of Health, Medicine and Caring Sciences, Center for Medical Image Science and Visualization and Department of Radiology, Linköping University, Linköping, Sweden
• Hanna Salé: PhD - Department of Neuroradiology, Center of Medical imaging and Physiology, Skåne University Hospital, Lund, Sweden
• Martina Frodlund: PhD - Department of Biomedical and Clinical Sciences, Linköping University, Sweden
• Per Alstergren: Professor - Department of Orofacial Pain and Jaw Function, Malmö University, Sweden