Temporomandibular involvement in juvenile idiopathic arthritis.
OBJECTIVE
To study occurrence as well as clinical signs and symptoms of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) in a population representing all subtypes of JIA.


METHODS
Ninety-seven consecutive children with JIA underwent orthodontic evaluation including an orthopantomogram (OPG). Further evaluation included patient characteristics, disease onset, course, and medical treatment.


RESULTS
Forty-five percent of all children had TMJ involvement. Frequencies according to JIA subtypes: systemic 67%, oligoarticular (persistent and extended) 39%, rheumatoid factor (RF) negative polyarticular 59%, RF positive polyarticular 33%, enthesitis related arthritis 13%, psoriatic arthritis 33%, and other arthritis 50%. In children with a polyarticular course, irrespective of their disease onset, TMJ involvement was more frequent (55% vs 31% in oligoarticular course). In children with disease onset at a young age and/or an extended course of the disease, TMJ involvement was also more frequent. Pain during jaw excursion, absence of translation, asymmetry during maximal opening and protrusion, as well as crepitation during evaluation are predictors for TMJ involvement with a good specificity but a low sensitivity. Not all patients with TMJ involvement have clinical signs.


CONCLUSIONS
Because of the high prevalence and discrepancy between clinical signs and presence of arthritis of the TMJ, regular orthodontic evaluation and OPG is recommended to recognize TMJ involvement and enable early intervention.
Twilt
Marinka
M
Department of Pediatrics, Sp 1545, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. m.twilt@erasmusmc.nl
Mobers
Shell M L M
SM
Arends
Lidia R
LR
ten Cate
Rebecca
R
van Suijlekom-Smit
Lisette
L
D000293:Adolescent; D001171:Arthritis, Juvenile / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*