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Background  Up to 80% of children with juvenile idiopathic arthritis (JIA) develop arthritis involving their temporomandibular joint (TMJ). Recent studies have questioned the sensitivity of an abnormal MRI in the diagnosis of active arthritis.    Methods  122 children without arthritis undergoing contrast MRI of the head were prospectively consented to undergo a simultaneous contrast MRI of their TMJs. As a comparison point, the initial MRI of the TMJ of 35 newly diagnosed children with JIA were retrospectively scored. The presence and size of effusion and contrast enhancement were measured in the left TMJ in all subjects.    Results  62/122 (51%) controls compared to only 10/35 JIA (29%) patients had an effusion ( p  = 0.022). Contrast enhancement was present in ≥97% of both groups, although the size of the enhancement was, on average, 0.2 mm larger in controls (1.1 ± 0.24 vs 0.88 ± 0.27 mm,  p  <  0.001). Among JIA patients, the size of the enhancement correlated inversely with disease duration ( r  = − 0.475,  p  = 0.005). Chronic changes were present in none of the controls versus 2/35 (5.5%) of the JIA patients ( p  = 0.049).    Conclusion  Findings consistent with minimally active TMJ arthritis appear to be equally likely in children with JIA as compared to non-inflamed controls, while this and other studies confirm that chronic changes are specific to JIA. Thus, small amounts of effusion or contrast enhancement, in the absence of chronic changes, should be interpreted with caution.    Electronic supplementary material  The online version of this article (10.1186/s12969-018-0223-3) contains supplementary material, which is available to authorized users.

pediatric rheumatology online journal

Defining the normal appearance of the temporomandibular joints by magnetic resonance imaging with contrast: a comparative study of children with and without juvenile idiopathic arthritis