title: Temporomandibular condylar alterations in juvenile idiopathic arthritis most common in longitudinally severe disease despite medical treatment.
abstract: BACKGROUND
  Juvenile idiopathic arthritis (JIA) is an autoimmune, heterogeneous disease and the temporomandibular joint (TMJ) can be affected, with consequences for mandibular growth and function. The aim of this study was to evaluate the importance of longitudinal medical treatment and the burden of disease activity on the development of temporomandibular condylar alterations as judged on panoramic radiographs.
  
  
  METHODS
  The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to three specialist dental clinics in Sweden during an eight-year period. Data on the total pharmacological treatment and disease activity were evaluated longitudinally from disease onset to the time of the panoramic examination, during a median observation period of 2.5 years. The radiographs were analysed in terms of structural and shape alterations in the condyles and judged dichotomously.
  
  
  RESULTS
  Panoramic examinations were analysed in 158 patients from 266 referrals diagnosed with JIA. Condylar alterations (shape or structural) were seen in 68 patients (43%). Patients with condylar alterations were more extensively treated over time compared with those without condylar alterations. Powerful disease activity and/or potent medication at any time during the course of the disease implied an increased risk of alterations.
  
  
  CONCLUSIONS
  Patients with JIA who require more intensive medication over time run the greatest risk of condylar alterations. As yet, current medical programmes have not been specified for the TMJ and more knowledge in this area is needed.
authors.affiliation: Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Anna-Lena
authors.initials: AL
authors.lastname: Cedströmer
authors.affiliation: Department of Oral and Maxillofacial Radiology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Ahlqwist
authors.affiliation: Department of Orthodontics, Eastman Institutet, Folktandvården Stockholms län AB, Stockholm, Sweden ; Department of Surgical Sciences, Oral and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Andlin-Sobocki
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Lillemor
authors.initials: L
authors.lastname: Berntson
authors.affiliation: Department of Dental Medicine, Section for Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, Sweden ; Department of Clinical Oral Physiology, Eastman Institutet, Folktandvården Stockholms län AB, Stockholm, Sweden.
authors.forename: Britt
authors.initials: B
authors.lastname: Hedenberg-Magnusson
authors.affiliation: Department of Behavioral and Community Dentistry, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Dahlström
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D051445:Fibrocartilage / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008335:Mandibular Condyle / Q000000981:diagnostic imaging* / Q000473:pathology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013548:Sweden; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology
chemical_list: D018501:Antirheumatic Agents
keywords: Adolescent; Arthritis juvenile rheumatoid/diagnoses; Child; Retrospective studies; Temporomandibular joint