Five recommendations are proposed for the orofacial examination of patients with JIA to improve the clinical practice and aid standardized data collection for future studies. The task force has formulated a future research program based on the proposed recommendations.

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Objective.To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA).Methods.Using a sequential expert group–defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus.Results.Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction.Conclusion.Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.

Objectives: To estimate the cumulative incidence of arthritis-induced orofacial symptoms, dysfunctions, and dentofacial deformities in growing individuals with juvenile idiopathic arthritis (JIA) in a 36 month regional cohort study, and to identify predictors for the development of arthritis-induced dentofacial deformities.Methods: Data was retrieved from the Aarhus JIA TMJ cohort register, which contains standardized, longitudinal, observational data regarding orofacial conditions in patients with JIA (n=1040). This regional cohort represents the majority of all subjects with JIA from the western part of Denmark between 1990 and 2016, regardless of temporomandibular joint (TMJ) arthritis status. Cumulative incidences of orofacial conditions were reported using Kaplan-Meier methods and predictors for dentofacial deformity was identified using Cox proportional hazard analysis.Results: Follow-up data from 351 subjects over thirty-six months was included in this study.Median age at first clinical examination was 6.6 years (25/75 centiles: 4.9 and 9.9 years).Orofacial symptoms and dysfunction were common findings at 36 months after the first clinical examination and approximately five years after JIA onset, with a cumulative incidence of 38% and 53%, respectively. Dentofacial deformities were found in 35% of

Unilateral temporomandibular joint (TMJ) arthritis in juvenile idiopathic arthritis (JIA) patients often induces asymmetric dentofacial growth. This study evaluates the effects of an orthopaedic functional appliance worn full time to reduce asymmetric mandibular growth in JIA patients. Twenty-two JIA patients with unilateral TMJ involvement were included in the study (mean age 7.5 years, range: 3.8-13.8 years). They all received orthopaedic treatment with a functional appliance, a so-called distraction splint (mean treatment time 57 months). Panoramic tomograms or cone beam-computerized tomograms were taken before and within 12 months after treatment cessation. At both time points, the ratio between the healthy and the affected side of the mandible was evaluated in terms of inter-side differences in condylar height, ramus height, and total vertical mandibular height. Orthopaedic functional treatment reduced mandibular asymmetries in terms of ramus height and total vertical mandibular height (P < 0.05). Mandibular growth rates in the affected and the non-affected sides were comparable in most patients. Our study finds evidence to support that a distraction splint can normalize mandibular vertical growth in the affected side. We therefore suggest implementation of distraction splint therapy in the treatment of JIA patients with unilateral TMJ arthritis.

Counting of plasma cells in the SSCT showed that corticosteroids reduced the inflammation, but did not eliminate it. Semiquantitative scoring of synovial proliferation and inflammation demonstrated low sensitivity regarding changes in immunomodulation in antigen-induced arthritis compared to stereological quantitative estimations using an optical fractionator.

The aim of this investigation was to study the effect of intra-articular (i.a.) corticosteroid injections (IACIs) in the temporomandibular joint (TMJ) on mandibular development in antigen-induced TMJ arthritis. Ten-week-old female New Zealand white rabbits (n = 42) were randomly divided into four groups: group A, control (no injections); group B, placebo (repeated i.a. TMJ saline injections); group C, untreated arthritis (repeated induction of TMJ arthritis); and group D, steroid (repeated induction of TMJ arthritis + IACI). All animals had two tantalum implants inserted in the right side of the mandible serving as stable landmarks for later growth analysis. One implant was inserted close to the symphysis and one in the molar region. Computerized tomographic (CT) full-head scans were carried out at 14 (T1) and 26 (T2) weeks of age. (Dropout of animals at T2; group C, n = 7, and group D, n = 3.) Absolute and relative intra- and inter-group growth variations were evaluated during the growth period by comparison of CT scans. One-way analysis of variance was used for T1 statistical analysis, and absolute intra-group and relative inter-group growth differences between T1 and T2 were evaluated by Student's t-tests. At T2, the animals in the group A had greater sagittal and vertical mandibular growth compared with the other three groups. TMJ arthritis caused diminished mandibular growth. However, relative mandibular growth was significantly less in group D. The findings of this study do not indicate a positive long-term effect in the use of IACI in the TMJ as an early treatment intervention against TMJ inflammation in growing individuals.