Pediatric Rheumatology Online Journal → June 2003 → Miscellaneous Topics→ Abstract #82

TEMPOROMANDIBULAR JOINT INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS

M. Twilt, M. L. M. Mobers, L. R. Arends, R. Ten Cate, L. W. A. Van Suijlekom-Smit

¹Pediatrics, Erasmus MC University Hospital Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands; ²Orthodontics, Erasmus MC University Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands; ³Epidemiology & Biostatistics, Erasmus MC University Medical Centre Sophia Children's Hospital, Rotterdam, Netherlands; ⁴Pediatrics, Leiden University Medical Centre, Leiden, Netherlands

Background. In different studypopulations a great variation in frequencies 17-87% of temporomandibular joint (TMJ) involvement in the different Juvenile idiopathic Arthitis (JIA) subtypes is found. These joints can be affected uni- or bilateral, sometimes early in the course of the disease or can even be the initial joints. TMJ involvement untreated can lead to devastating complications, such as the "bird-face" due to the position of the growth center on the surface of the condylar heads. Clinical signs of TMJ involvement are scarce but if present good predictors.
Objectives. To study occurance as well as clinical signs and symptoms of TMJ in JIA in a population representing all JIA subtypes.
Methods. 97 consecutive children with JIA underwent amnestic and physical orthodontic evaluation, including orthopantomogram. Futher information obtained included, patient characteristics, disease onset and course, and medical treatment.
Results. Of all children 44% had TMJ involvement. Frequencies according to JIA subtypes: systemic 67%; oligoarticular 39%; rheumatoid factor negative polyarticular 59%; rheumatoid factor positive polyarticular 33%; enthesitis related athritis 13%; psoriatic arthritis 33%; other arthritis 50%. In children with a polyarticular course, also after systemic or oligoarticular onset TMJ involvement is more frequent (55%). Pain during jaw excursion, absence of translation, asymmetry during maximal opening and protrusion and crepitation during evaluation are good predictors for TMJ involvement. The fact remains that not al patients show clinical signs when TMJ involvement occurs.
Conclusion. Because of the frequent occurance and discrepancy between clinical signs and presence of arthritis of the TMJ, regular orthodontic evaluation is recommended to recognise TMJ involvement and for early intervention.