{
  "abstract": "Introduction Systemic sclerosis (SSc) may involve the temporomandibular joints (TMJ), contributing to musculoskeletal morbidity. Ultrasound (US) is increasingly recognized as a valuable tool for TMJ assessment. This study aimed to investigate the prevalence of TMJ clinical and US involvement in SSc patients and to compare the sensitivity of US versus clinical examination in detecting TMJ abnormalities.Material and Methods In this two-center case–control study with an embedded cross-sectional analysis, consecutive SSc patients fulfilling the 2013 ACR/EULAR criteria underwent clinical TMJ assessment and US evaluation by two independent blinded operators. Clinical signs/symptoms and US TMJ alterations were compared to matched healthy controls (HC). Active synovitis was defined by the presence of Power Doppler (PD) signal. The Mouth Handicap in Systemic Sclerosis scale (MHISS) and the University of California, Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract (UCLA-SCTC-GIT) 2.0 questionnaires were administered.Results Sixty-two SSc patients [16 diffuse and 46 limited SSc; M:F ratio 1:9; median age 63.2 (IQR 15.7) years; median disease duration 7.0 (IQR 11.8) years] and twenty-four HCs were included. At least one clinical sign or symptom of TMJ disorder was observed in 45.2% of SSc versus 0.0% of HC (p<0.0001). Chewing pain was the most common symptom (24.2%), and TMJ tenderness the most common sign (24.2%). US abnormalities in SSc included: synovial hypertrophy (43.5%), PD positivity (8.1%), erosions (6.5%), cartilage thinning (37.1%), calcifications (4.8%), cortical irregularities (50.0%), osteophytes (19.4%), flattening (21.0%), and altered dynamic assessment (16.1%). Compared with HC, SSc had higher rates of synovitis (p=0.002), cortical irregularities (p<0.001), and osteophytes (p=0.017). Active US synovitis ( figure 1) was associated with Scl-70 positivity (p=0.009), microstomia (p=0.016), younger age (p=0.006), and younger age at diagnosis (p=0.005). It correlated with lower UCLA-SCTC-GIT bloating scores (p=0.044), higher MHISS mouth-opening scores, and reduced inter-incisal distance (p=0.044). The prevalence of at least one clinical sign/symptom (45.2%) was lower than that of at least one US abnormality (87.1%) in SSc (p<0.001). US abnormalities were also more frequent in SSc than HC (87.1% vs 29.2%; p<0.001).Conclusions TMJ clinical involvement and US-detected synovitis are more common in SSc than in HC. Chewing pain and TMJ tenderness are the most common symptom and sign, respectively. US shows greater sensitivity than clinical examination in detecting TMJ abnormalities. Active synovitis is associated with microstomia and reduced mouth opening. Early US detection may provide insights into the prevention of orofacial complications in SSc.Abstract P.379 Figure 1Longitudinal ultrasound image of the TMJ in closed-mouth position in a patient with SSc, demonstrating synovial proliferation with positive PD signal and joint effusion",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Alessia Laneri"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Giovanni Ciancio"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Gabriele Amati"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Beatrice Maranini"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Amelia Spinella"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Marco De Pinto"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio, Modena, Italy"
      ],
      "name": "Martina Orlandi"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Maria Grazia Malandra"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio, Modena, Italy"
      ],
      "name": "Ottavio Secchi"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy"
      ],
      "name": "Benedetta Bongiovanni"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio, Modena, Italy"
      ],
      "name": "Gilda Sandri"
    },
    {
      "affiliations": [
        "Unit of Cranio-Maxillofacial Surgery, Department of Cranio-Maxillofacial Surgery, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Stefano Mandrioli"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Andrea Lo Monaco"
    },
    {
      "affiliations": [
        "Rheumatology Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy"
      ],
      "name": "Marcello Govoni"
    },
    {
      "affiliations": [
        "Rheumatology Unit, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy",
        "Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio, Modena, Italy"
      ],
      "name": "Dilia Giuggioli"
    }
  ],
  "title": "P.379 The involvement of the temporomandibular joint in patients with systemic sclerosis: a clinical and ultrasound study",
  "uid": "68fce888-af1f-5f8e-9bf4-e0443d79707b"
}