Osteonecrose de mandíbula em pacientes com lúpus eritematoso sistêmico juvenil observada em exame de imagem
Revista Brasileira de Reumatologia
We declare no conflict of interest. Pediatric Rheumatology Unit of the Children's institute (iCr, from the Portuguese), Department of Rheumatology, and odontology Division of the Hospital das Clínicas (HC) of the Medical School of Universidade de São Paulo (FMUSP) 1. Master's Degree in Sciences from FMUSP. Pediatric Rheumatologist Unit and Physician of the Fleury institute 2. Rheumatology Resident at the Pediatric Rheumatology of the children's institute (iCr) of Hospital das Clínicas (HC) of
... Clínicas (HC) of the Medical School of Universidade de São Paulo (FMUSP) 3. Master's Degree in Sciences from FMUSP. odontologist of the odontology Department of HC-FMUSP 4. PhD in odontology from FMUSP. odontologist of the odontology Department of HC-FMUSP 5. PhD in Radiology from FMUSP. Associate Physician of the Pediatric Radiology Unit of iCr-HC-FMUSP 6. Professor of the Pediatrics Department of FMUSP. Chief of the Pediatric Rheumatology Unit of iCr-HC-FMUSP iNTRoDUCTioN Juvenile systemic lupus erythematosus (JSLE) is an autoimmune disorder affecting several organs and systems, with a wide range of manifestations that can involve the masticatory system and oral mucosa. 1, 2 Orofacial involvement in JSLE has not been the focus of a large number of studies. In a recent study, we evaluated 48 patients with JSLE versus 48 age-and gender-matched healthy individuals, and we identified higher incidence of bacterial plaque and gingival bleeding in lupus patients. 3 ABSTRACT Objective: The objective of the present study was to evaluate radiographic changes of the temporomandibular joint (TMJ) in patients with juvenile systemic lupus erythematosus (JSLE) and a control group. Patients and Methods: Panoramic radiographies of the TMJ of 26 JSLE patients and 28 healthy individuals were evaluated. Multislice computed tomography (MCT) was performed on those patients who presented flattening and/or destruction of mandibular condyles. Demographic data, oral health indices, clinical manifestations, laboratorial exams, and treatment were evaluated. Results: Important radiographic changes consistent with osteonecrosis of the mandible, confirmed by MCT of the TMJ, were observed in 2/26 (8%) JSLE patients versus 0% in the control group (P = 0.22). Mild clinical dysfunction and abnormal TMJ mobility were observed in 67% and 54% of the patients, respectively. Age of onset, disease duration, and current age were similar in JSLE patients with and without severe radiographic changes of TMJ (9.3 versus 10.8 years, P = 0.77; 3.3 versus 2 years, P = 0.63; 12.6 versus 13.5 years, P = 0.74, respectively). Significant differences in gender, socioeconomical status, oral health indices, clinical manifestations, laboratorial exams, and treatment were not observed between both subgroups (P > 0.05). Both JSLE patients with osteonecrosis of the mandible had active chronic disease, used corticosteroids for a prolonged period, and had mild TMJ dysfunction. Antiphospholipid antibodies were not observed in those two patients, and neither one had been treated with bisphosphonate. Conclusions: Osteonecrosis of the mandible with mild TMJ dysfunction was observed in some of the patients, demonstrating the importance of odontological assessment during clinical follow-up.