Longterm Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis: 17 Years of Followup of a Nordic Juvenile Idiopathic Arthritis Cohort

Abstract

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 to 2000, 420 consecutive cases were eligible for orofacial evaluation of TMJ involvement. The followup visit included demographic data, a standardized clinical orofacial examination, and full-face 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 yrs) and completed a standardized clinical orofacial examination. Of these, 245 had a full-face CBCT performed. At least 1 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. Further, among participants reporting complaints, the number of symptoms was also higher in 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 study of the longterm 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 followup of JIA patients also in adulthood.

Fatigue in young adults with juvenile idiopathic arthritis 18 years after disease onset: data from the prospective Nordic JIA cohort

“…The 18-year follow-up was composed of a study visit with clinical examination, including a full joint examination performed by experienced pediatric rheumatologists to explore whether the participants had active joints and/or restricted joints. In addition, a temporomandibular joint (TMJ) examination by a dentist, and an eye examination by an ophthalmologist were performed [22,23]. We also registered ongoing and previous medication, disease status and damage, blood tests, selfreported questionnaires on health and HRQoL, including fatigue and sleep questionnaires and participation in school/work.…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…Glerup et al 346 determined the prevalence of TMJ/orofacial symptoms, dysfunctions, and deformities associated with juvenile idiopathic arthritis (JIA) 17 years after disease onset. Data were extracted from a prospective, population-based Nordic JIA cohort with disease diagnosis from 1997 to 2000.…”

Initial radiological signs of dentofacial deformity in juvenile idiopathic arthritis

“…TMJ arthritis can lead to deformation of joint components, which is accompanied by orofacial signs and symptoms having a negative impact on quality of life 5 – 9 . These orofacial manifestations of JIA can present from disease onset and persist into adulthood 6 , 9 . Progression of JIA manifestations can also occur in systemically well-treated patients where TMJ inflammation has resolved 10 .…”

“…A recent regional-based cohort study found that 35 per cent of skeletally immature subjects with JIA developed radiological signs of dentofacial deformity within 5 years after onset of JIA disease 9 . In addition, recent population-based data found that 61 per cent of subjects with JIA had radiological signs of TMJ deformities 17 years after disease onset 6 .…”