title: Frequency and Morbidity of Temporomandibular Joint Involvement in Adult Patients With a History of Juvenile Idiopathic Arthritis.
abstract: OBJECTIVE
  Most patients with juvenile idiopathic arthritis (JIA) have temporomandibular joint (TMJ) involvement, but little is known about the natural history of TMJ disease as these children enter adulthood. The purpose of this study was to evaluate adults with a history of JIA to document the frequency and severity of TMJ abnormalities and morbidity. The authors hypothesized that most would have persistent TMJ disease as adults.
  
  
  METHODS
  This cross-sectional study included adults (>19 years of age) with JIA who were managed at Boston Children's Hospital (BCH) as children and at Brigham and Women's Hospital (BWH) as adults. History of a TMJ problem was not considered for enrollment. Patients completed a questionnaire and underwent physical examination and maxillofacial cone-beam computed tomography (CBCT). Additional data were obtained from medical records. Associations between TMJ abnormalities at CBCT and arthritis history, TMJ pain and function, facial asymmetry, malocclusion, and cephalometric analysis were examined.
  
  
  RESULTS
  Of 129 eligible patients contacted, 21 (42 TMJs) were enrolled. Mean age was 26.0 ± 6.1 years and mean duration of care for JIA at the BCH and BWH was 13.7 ± 6.5 years. TMJ pain was present in 62% of patients (n = 13); 43% (n = 9) had a TMJ functional limitation and 76% (n = 16) had lower facial asymmetry. Abnormalities were found in the TMJs on 55% of CBCT scans, with 79% showing bilateral deformities. There was at least 1 cephalometric measurement of mandibular size or position that was more than 1 standard deviation beyond normal in 81% of patients (n = 17). Only 4 patients (19%) had previously been evaluated for a TMJ problem.
  
  
  CONCLUSIONS
  TMJ abnormalities and related morbidity are common in adult patients with a history of JIA. Therefore, an early screening protocol for TMJ involvement in children with a new diagnosis of JIA would be beneficial and long-term follow-up into adulthood should be routine.
authors.affiliation: Instructor, Harvard School of Dental Medicine, Boston; Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA. Electronic address: cory.resnick@childrens.harvard.edu.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Resnick
authors.affiliation: Research Fellow, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Rushil
authors.initials: R
authors.lastname: Dang
authors.affiliation: Instructor, Harvard Medical School, Boston; Pediatric Rheumatologist, Division of Immunology, Program in Rheumatology, Boston Children's Hospital, Boston, MA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Henderson
authors.affiliation: Instructor, Harvard Medical School, Boston; Neuroradiologist, Massachusetts Eye and Ear Infirmary, Boston, MA.
authors.forename: David A
authors.initials: DA
authors.lastname: Zander
authors.affiliation: Research Data Manager, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Daniels
authors.affiliation: Associate Professor, Harvard Medical School, Boston; Pediatric Rheumatologist, Division of Immunology, Program in Rheumatology, Boston Children's Hospital, Boston; Director, Center for Adults with Pediatric Rheumatic Illness, Brigham and Women's Hospital, Boston, MA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Nigrovic
authors.affiliation: Walter C. Guralnick Distinguished Professor, Harvard School of Dental Medicine, Boston; Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
mesh_terms: D000328:Adult; D001171:Arthritis, Juvenile / Q000150:complications*; D002508:Cephalometry; D054893:Cone-Beam Computed Tomography; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000209:etiology*