Abstract
BackgroundJuvenile idiopathic arthritis (JIA) is a heterogeneous disease that frequently affects also the temporomandibular joint (TMJ) and associated structures. The main aim of this observational study was to describe systematically orofacial clinical signs and subjective symptoms in JIA patients, classified according to the International League of Associations for Rheumatology (ILAR) criteria, and to relate the findings to disease activity and radiological TMJ condyle lesions.MethodsThe study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to one of three dental specialist clinics in Sweden during an eight-year period. Data concerning temporomandibular signs, symptoms and general disease activity were collected and condylar alterations were judged on panoramic radiographs.ResultsAll ILAR categories of JIA were represented among the 266 referrals included in the study. The distribution of patients among categories resembled the pattern seen in epidemiological studies. Persistent oligoarthritis was the largest category with 36.5% of the patients. Temporomandibular clinical signs (mild, moderate or severe) occurred in 57.7% to 92.0%, and subjective symptoms (mild or severe) in 32.0% to 76.0% of the patients in all categories. Patients in the juvenile psoriatic arthritis category had the largest number of orofacial signs and symptoms, and patients in the persistent oligoarthritis category had the fewest signs and symptoms. There were significant associations between clinical signs as well as subjective symptoms and overall disease activity. Half of all the patients had undergone panoramic examinations and 37.9% of those were judged to have condylar alterations after a mean of 2.9 years after onset. No associations between radiological findings and variables, such as signs, symptoms or disease activity, were found.ConclusionsTemporomandibular signs and symptoms can be expected to a varying degree, including severe cases, in all JIA categories. Clinical and subjective orofacial involvement appears to be related to disease activity but not to condylar lesions.
Highlights
Juvenile idiopathic arthritis (JIA) is a heterogeneous disease that frequently affects the temporomandibular joint (TMJ) and associated structures
Juvenile idiopathic arthritis (JIA) is a generic term for arthritis with unknown etiology and with the onset occurring before the age of 16 [1]
The main aim was to describe systematically the clinical and subjective involvement of the TMJ and associated structures in pediatric patients diagnosed with JIA, categorised according to the International League of Associations for Rheumatology (ILAR) criteria, and referred to dental specialist clinics
Summary
All consecutive patients who fulfilled the ILAR criteria of JIA [1] and who were referred by physicians or dentists during an eight-year period to one of three specialist dental clinics in Sweden were included. Data were collected from the first examination by the specialist dentist (study visit), which took place between January 1, 1999, and December 31, 2006. A systematic clinical assessment, according to structured protocols, of orofacial signs was made by a specialist dentist at the study visit. Anamnestic data relating to subjective symptoms, the Helkimo’s anamnestic index, Ai 0-II, summarize TMJ sounds, fatigue/stiffness of the jaw, pain, difficulty of jaw movements, locking and luxation. Data were collected by the same dentist from the medical records at the pediatric rheumatology clinics where the participating patients were treated. Twotailed statistical analyses were performed at a significance level of P < 0.05, unless otherwise stated
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