Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: Challenges in Diagnosis, Treatment, and Outcomes

Abstract

Juvenile idiopathic arthritis (JIA) is the most common arthritis in the pediatric population. Manifestation of arthritis in the temporomandibular joint (TMJ) presents unique challenges in diagnosis and treatment. This review critically analyzes recent literature, emphasizes new findings, and offers guidance on controversial clinical practices. Imaging: Magnetic resonance imaging with gadolinium contrast (Gd-MRI) is the current gold standard for diagnosis. A new TMJ-MRI scoring system has been developed by the Omeract JIA interest group. Clinical examination: Consensus-based clinical orofacial examination recommendations for monitoring patients have been developed and are currently validated. Treatment: Treatment of TMJ arthritis includes local and systemic drug therapy, treatment with orthodontic devices, and potentially maxilla-facial surgery. A novel Gd-MRI scoring system and clinical examination recommendations for evaluating TMJ arthritis in JIA patients are available, enabling physicians to compare patients and treatment responses. Intra-articular injections should only be used in certain patients with caution. A combination of systemic medications combined with orthodontic appliances is necessary to treat these patients, warranting a multidisciplinary approach.