Juvenile idiopathic arthritis and the temporomandibular joint

The temporomandibular joint [TMJ] is one of the most underdiagnosed and undertreated conditions of juvenile idiopathic arthritis [JIA] because its involvement is often asymptomatic and the joint is difficult to examine. The aim of this study was to investigate clinical as well as magnetic resonance imaging findings of temporomandibular joint inflammation among juvenile idiopathic arthritis patients and to detect the correlation between them, moreover with different disease parameters. Forty patients with JIA and 10 apparently healthy control subjects underwent clinical and post contrast magnetic resonance imaging [MRI] examinations for TMJs. MRI findings were scored. Clinical and laboratory disease parameters were recorded. The clinical symptoms and signs of TMJ arthritis were detected in 35% and 62.5% of JIA cases, respectively. While TMJ disease was observed in 80% of patients using contrast enhanced MRI. The mean total MRI score was significantly higher in patients with active disease compared to those without activity. Patients with systemic and polyarticular JIA showed significant increase in the mean of synovial enhancement, effusion and total MRI scores compared to those with the oligoarticular type. MRI abnormalities revealed significant association with clinical signs of TMJ examination but not with symptoms. Synovial enhancement score showed significant positive correlation with disease activity score and C-reactive protein as a marker of inflammation. A significant positive correlation was found between total MRI score and disease activity, functional and pain scores in patients with JIA. TMJ arthritis is common among patients with JIA, therefore; examination of the TMJ is mandatory during the follow up of patients. Clinical signs of TMJ arthritis can be used as filter for MRI examination TMJ is an important joint which may be considered during categorizing JIA patients in different subtypes

Preclinical atherosclerosis and rheumatoid arthritis

Cardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in rheumatoid arthritis [RA]. Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in RA. To study the relative impact of traditional versus non-traditional cardiovascular risk factors on endothelial dysfunction, as an early essential step for atherosclerosis, in patients with RA. Twenty five consecutive outpatients with RA were collected and compared to 15 healthy, age and sex matched controls.Both groups undergone assessment of traditional cardiovascular risk factors [high blood pressure, diabetes and smoking] as well as other non- traditional cardiovascular risk factors [hs CRP, ESR, serum ICAM] along with bilateral measurement of intima media thickness IMT of common carotid artery [IMT-CCA]. There was highly significant difference in T-chol /HDL [cardiac risk ratio] between the two groups [RA patients and controls]. Also there was a highly significant difference between the two groups as regards inflammatory markers [non-traditional risk factors], IMT and s-ICAM. RA patients with increased IMT-CCA had higher T-chol/ HDL [cardiac risk ratio] [P < 0.05], as well as high DAS and ESR [P < 0.01] compared to RA patients with normal IMT-CCA. Patients with positive RF had increased IMT-CCA [P < 0.05] and higher serum levels ICAM-1[P < 0.01] than those with negative RF. We also found that IMT-CCA was significantly positively correlated to markers of disease activity, while serum levels ICAM-1 was significantly positively correlated to disease duration. Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and disease severity are atherogenic to this population. That is why proper and strict control of disease activity may play a preventive role in this setting