The pathogenesis of reduced mandibular dimensions and asymmetry was studied in 103 patients with juvenile rheumatoid arthritis. Abnormalities of the temporomandibular joint were intimately related to mandibular growth disturbances. Unilateral joint abnormality resulted in jaw asymmetry and underdevelopment on the affected side. Duration of disease and of corticosteroid therapy, age at disease onset, and age when the data were recorded were correlated with the size of the mandible. Our findings did not support a hypothesis of cervical spine involvement as an etiologic factor of reduced mandibular size.

The typical craniofacial morphological pattern in JIA patients was established between 9 and 12 years of age. From the age of 12 until the age of 35, this morphological pattern remained relatively stable, in contrast to the pattern in the healthy control subjects.

A prospective study of 100 children aged 2-17 years (68 girls) with juvenile rheumatoid arthritis (JRA) was initiated to follow changes in the temporomandibular joint (TMJ), growth of the craniofacial complex and development of the dental occlusion, and to relate the findings to clinical and laboratory parameters. The mean age at onset was 5.5 years. The debut type was acute febrile in 14, pauciarticular in 64, and polyarticular in 22 patients. At examination, at mean age 9 years, 45 patients had pauci- and 55 polyarticular JRA. Definite radiographic TMJ changes were found in 41 patients (unilaterally in 17). 130 children without joint disease served as controls. Of the patients with radiographic TMJ changes, 65% had clinical symptoms and/or signs, the most frequent being restricted mouth opening. Of the patients without radiographic TMJ changes, 19% had uncertain clinical findings (pain, tenderness or slightly restricted mouth opening). Radiographic TMJ changes were significantly related to early onset of JRA, long disease duration, actual polyarticular type, high disease activity, impaired functional capacity and general health, splenomegaly and kidney involvement, low hemoglobin and high gammaglobulin concentrations. A significant relationship was also found with radiographic changes of the cervical spine. Radiographic examination seemed essential for the diagnosis of TMJ arthritis.

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The present report is a longitudinal study of the craniofacial growth, based on lateral cephalographs of a group of 26 patients with juvenile rheumatoid arthritis (JRA), and a matched English control group. In the 26 matched pairs, the mean age at baseline was 8.4 years and at 6-year follow-up 14.7 years, female/male ratio was 3.3/1, and all patients had temporomandibular joint (TMJ) abnormalities. The study revealed obvious growth disturbances in the facial skeleton in the children with JRA. Compared with the controls, the patients showed a smaller mandible with an altered morphology and position. The mandible became more retruded by rotating posteriorly, around a centre in the molar region, and was characterized by appositional growth in the gonion area, vertical growth in the anterior part and proclination of the lower incisors. During the observation period the growth disturbances became more pronounced, reflecting the progressive nature of the abnormal development. Based on these findings, a future aspect of research in this field could be TMJ surgery and orthognathic surgery in an early stage, trying to avoid this unfavourable facial development.