Temporomandibular Joint

Right Posterior Oblique Lumbar Spine

Fig. 10.41A, B Rheumatoid apophysitis in the lumbar spine. A Right posterior oblique radiograph of the lower lumbar spine in a 63-year-old woman with rheumatoid apophysitis of L3 and L4 vertebrae shows articular blurring and periarticular bone erosions (open arrows). B Posterior pinhole scintigraph reveals moderately increased tracer uptake in L3 and L4 apophyseal joint on the right (arrows). Note the typical astride position of the apophyseal joint at this level

The temporomandibular joints are involved not infrequently in rheumatoid arthritis. Radiographic changes include osteopenia, sub-chondral bone erosions, narrowing or apparent widening of the mandibular fossa, locking or limited articular excursion, and ankylosis (Fig. 10.44A). Pinhole scintigraphically, the

Fig. 10.41A, B Rheumatoid apophysitis in the lumbar spine. A Right posterior oblique radiograph of the lower lumbar spine in a 63-year-old woman with rheumatoid apophysitis of L3 and L4 vertebrae shows articular blurring and periarticular bone erosions (open arrows). B Posterior pinhole scintigraph reveals moderately increased tracer uptake in L3 and L4 apophyseal joint on the right (arrows). Note the typical astride position of the apophyseal joint at this level

Oblique Lumbar Spine Radiograph

Fig. 10.42 Diskovertebral rheumatoid arthritis with apophyseal joint involvement. Lateral pinhole scan of the lumbar spine in a 27-year-old female shows increased uptake in the L3 lower and L4 upper and lower endplates (arrows). Apophyseal joint involvement is also indicated by posterior tracer uptake (arrowhead)

Fig. 10.42 Diskovertebral rheumatoid arthritis with apophyseal joint involvement. Lateral pinhole scan of the lumbar spine in a 27-year-old female shows increased uptake in the L3 lower and L4 upper and lower endplates (arrows). Apophyseal joint involvement is also indicated by posterior tracer uptake (arrowhead)

rheumatoid arthritis of the temporomandibu-lar joint with remaining joint space and without ankylosis or sclerosis reveals intense tracer uptake that is well-confined to the joint. The area of uptake in a diseased joint is larger than in a normal joint, reflecting the ballooning of the eroded joint with reactive inflammation in the periarticular bones (Fig. 10.44B). When the joint is ankylotic with periarticular bone sclerosis, tracer uptake becomes decreased but diffusely spread with poor demarcation (Fig. 10.45). Such a finding is quite similar to that in ankylotic atlantoaxial rheumatoid arthritis (Fig. 10.43).

As in rheumatoid arthritis of other joints (Fig. 10.37), it is a general impression that relatively fresh temporomandibular rheumatoid arthritis with remaining joint space accumulates tracer rather intensely without diffusion

Median Atlantoaxial Joints

Fig. 10.43A, B Atlantoaxial rheumatoid arthritis. A Lateral radiograph of the upper cervical spine in a 33-year-old female shows blurring and apparent widening of the median atlantoaxial joint presumably due to erosion and fibrosis (arrow). B Lateral pinhole scan reveals poorly defined tracer uptake in diseased median atlantoaxial joint (arrow). Pinhole scan makes not only the diagnosis of specific joint involvement but also disease stage and activity

Fig. 10.43A, B Atlantoaxial rheumatoid arthritis. A Lateral radiograph of the upper cervical spine in a 33-year-old female shows blurring and apparent widening of the median atlantoaxial joint presumably due to erosion and fibrosis (arrow). B Lateral pinhole scan reveals poorly defined tracer uptake in diseased median atlantoaxial joint (arrow). Pinhole scan makes not only the diagnosis of specific joint involvement but also disease stage and activity

Median Atlantoaxial Joints

Fig. 10.44A, B Rheumatoid temporomandibular arthritis. A Oblique open-mouth radiograph of the right temporomandibular joint in a 51-year-old woman with established rheumatoid involvement reveals locking, articular narrowing and ballooning, and sclerosis and erosions (arrowheads). B Lateral pinhole scintigraph shows intense tracer uptake in the temporomandibular joint (arrow). The uptake is exaggerated reflecting the periarticular spread of inflammation and ballooning of the articular fossa. The sella turcica is presented as a "cold" fossa (s)

Fig. 10.44A, B Rheumatoid temporomandibular arthritis. A Oblique open-mouth radiograph of the right temporomandibular joint in a 51-year-old woman with established rheumatoid involvement reveals locking, articular narrowing and ballooning, and sclerosis and erosions (arrowheads). B Lateral pinhole scintigraph shows intense tracer uptake in the temporomandibular joint (arrow). The uptake is exaggerated reflecting the periarticular spread of inflammation and ballooning of the articular fossa. The sella turcica is presented as a "cold" fossa (s)

so that the diseased joint is well-defined (Fig. 10.44), whereas the less active lesions with joint space obliteration, ankylosis, and regional sclerosis accumulate tracer less intensely and diffusely so that the diseased joints are poorly defined (Figs. 10.35, 10.39, 10.43 and 10.45).

Intense Research

Fig. 10.45A, B Ankylotic rheumatoid arthritis of the temporomandibular joint with ill-defined and not-so-intense uptake. A Conventional tomogram of the right tem-poromandibular joint in a 26-year-old male shows ballooned fossa with erosion, ankylosis, and mandibular head lysis (arrow). B Lateral pinhole scan reveals increased tracer uptake with diffusely obliterated joint. The uptake is poorly defined and not as intense as the ankylotic type shown in Fig. 10.44

Fig. 10.45A, B Ankylotic rheumatoid arthritis of the temporomandibular joint with ill-defined and not-so-intense uptake. A Conventional tomogram of the right tem-poromandibular joint in a 26-year-old male shows ballooned fossa with erosion, ankylosis, and mandibular head lysis (arrow). B Lateral pinhole scan reveals increased tracer uptake with diffusely obliterated joint. The uptake is poorly defined and not as intense as the ankylotic type shown in Fig. 10.44

Arthritis Spine

Fig. 10.46A, B Insufficiency spinal fracture in rheumatoid arthritis treated with corticosteroid. A Posterior pinhole scintigraph of the midlumbar spine in a 54-year-old woman shows minimally arcuate, very intense tracer uptake in the lower endplate of the L2 vertebra and the upper endplate of the L3 vertebra (arrowheads). B Anteroposterior radiograph reveals compression fracture with eburnation in the upper endplate of the L3 vertebra (arrows). The L2 vertebral fracture is not indicated radio-graphically

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