Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. TMJ arthritis in growing individuals can cause deformation of facial skeleton (dentofacial deformity) and TMJ components (TMJ deformity). Treatment outcome hinges on early initiation of anti-inflammatory treatment and orthopaedic treatment with dental splints. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. We retrospectively studied 96 patients with JIA and 20 non-JIA controls to identify the initial radiological signs of JIA-induced dentofacial deformity leading to initiation of orthopaedic treatment. We found that initial radiological signs of dentofacial deformities were subtle and characterized by minor mandibular asymmetry and occlusal plane steepening. Radiological findings of TMJ deformity associated with initial dentofacial deformity were frequent and characterized by condylar articular surface flattening (OR 8.42), condylar subcortical cyst (OR 5.94), condylar surface erosion (OR 5.38) and condylar deviation in form (OR 25.39). Radiological signs of TMJ deformity were also documented in TMJs considered “healthy” during initial clinical and radiological examination. This study presents new knowledge of importance for early diagnosis of dentofacial deformity in JIA. Early diagnosis of dentofacial deformity is important as treatment outcome is greatly influenced by timely initiation.
Highlights
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved
Based on baseline clinical and radiological findings of TMJ involvement and dentofacial deformity, these participants were further subcategorized into the JIA+Uni group (n = 42, 57%) or the JIA+Bilat group (n = 32, 43%); 22 age-matched patients with JIA but without apparent TMJ involvement were assigned to the JIA- group
Research has indicated a non-linear relationship between the severity of JIAinduced facial deformity and the severity of the intra-articular TMJ d eformity[14]. This means that patients with pronounced TMJ deformity can present with only minor dentofacial deformity
Summary
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. 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[5,6,7,8,9] These orofacial manifestations of JIA can present from disease onset and persist into a dulthood[6,9]. Based on 3D CBCTs, the objectives of the present study were: (1) to identify the initial radiological signs of dentofacial deformity leading to initiation of orthopaedic treatment in patients with JIA and TMJ involvement. Based on 3D CBCTs, the objectives of the present study were: (1) to identify the initial radiological signs of dentofacial deformity leading to initiation of orthopaedic treatment in patients with JIA and TMJ involvement. (2) To characterize the initial intra-articular radiological signs of TMJ deformity associated with initial signs of facial deformity in patients needing orthopaedic treatment
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