Long-term Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis.

J Rheumatol 2019 09 15. Epub 2019 Sep 15.

From the Department of Pediatrics, Aarhus University Hospital, Denmark; Section of Orthodontics, Aarhus University, Denmark, Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Denmark; Department of Pediatrics, University Hospital of North Norway; Department of Clinical Medicine, Faculty of Health Sciences, UIT, The Arctic University of Norway, Tromsø, Norway; Department of Otorhinolaryngology and Department and Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Center of North Norway, Tromsø, Norway; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway; Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway; Department of Oral and Craniomaxillofacial Surgery, St. Olavs Hospital, Norway, NTNU; Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Oral and Maxillofacial Surgery/Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, Sweden; Hospital for Children and Adolescents, University of Helsinki, Finland; Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Finland; Department of Pediatrics, Copenhagen University Hospital, Denmark; Department of Pediatric Dentistry and Clinical Genetics, University of Copenhagen, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Denmark. Correspondence to: Mia Glerup, Department of Pediatrics, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark. Phone: +45 61333138. E-mail:

Objective: To determine the prevalence of orofacial symptoms, dysfunctions, and deformities of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) 17 years after disease onset.

Methods: Drawn from a prospective, population-based Nordic JIA cohort with disease onset from 1997-2000, 420 consecutive cases were eligible for orofacial evaluation of TMJ involvement. The follow-up visit included demographic data, a standardized clinical orofacial examination, and fullface cone-beam computed tomography (CBCT). For comparison, 200 age-matched healthy controls were used.

Results: Of 420 eligible participants with JIA, 265 (63%) were included (mean age 23.5 ± 4.2 years) and completed a standardized clinical orofacial examination. Of these, 245 had a full-face CBCT performed. At least one orofacial symptom was reported by 33%. Compared to controls, the JIA group significantly more often reported TMJ pain, TMJ morning stiffness, and limitation on chewing. Furthermore, among participants reporting complaints, the number of symptoms was also higher in the JIA. The mean maximal incisal opening was lower in the JIA group (p<0.001), and TMJ pain on palpation was more frequent. Condylar deformities and/or erosions were observed in 61% as assessed by CBCT, showing bilateral changes in about 70%. Risk factors of condylar deformities were orofacial dysfunction or biologic treatment; enthesitis-related arthritis was protective.

Conclusion: This first study on long-term consequences of TMJ involvement in a population-based JIA cohort reports persistence of comprehensive symptoms, dysfunctions, and damage of the TMJ into adulthood. We suggest interdisciplinary follow-up of JIA patients also in adulthood.

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http://dx.doi.org/10.3899/jrheum.190231DOI Listing
September 2019
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