Contemporary management of TMJ involvement in JIA patients and its orofacial consequences

Abstract

Juvenile idiopathic arthritis is the most common chronic rheumatic condition during childhood. Temporomandibular joint arthritis is frequently asymptomatic. When it takes place during childhood, it may affect condylar growth; therefore, these children are at risk of unfavorable long-term outcomes from the associated joint damage. The etiology is not completely understood, but it is considered as multifactorial with both genetic and environmental factors involved.The standardized examination and imaging protocols serve important purpose to diagnose temporomandibular joint (TMJ) arthritis not only to establish an early interventional strategy but also to assess craniofacial growth and the progression of signs and symptoms in those patients. Although the treatment of juvenile idiopathic arthritis (JIA) has changed dramatically over the last decades due to new therapeutic options, TMJ arthritis still can develop during the course of the disease. In clinical experience, TMJs appear to respond less well to the standard of care used to treat other joints. More individualized approach to the patient’s treatment serves as the main goal of personalized medicine. It could be achieved by adopting new methods of medical imaging such as conebeam computer tomography as well as developing reliable biomarkers which may assist with predicting disease type, course, or severity and predicting response to medication.This article provides an overview of current information on orofacial complications in JIA and its management. Based on information provided in this review, more precise diagnosis, proper tools for recognizing people at risk, and more efficient treatment approaches could be implemented. This may lead to more personalized treatment management strategies of TMJ complications of JIA patients.

Quantitative analysis of facial asymmetry based on three-dimensional photography: a valuable indicator for asymmetrical temporomandibular joint affection in juvenile idiopathic arthritis patients?

“…Previous reports indicate that certain facial morphological features, such as an antegonial notching or chin asymmetry, could be interpreted as signs of impaired growth representing a structural damage in the TMJ [11,12]. As arthritis of the TMJ is frequently asymptomatic, a dependable facial examination could serve an important purpose to disclose possible craniofacial growth deficiency and to establish a timely interventional strategy [13]. With the introduction of three-dimensional (3D) photography as documentation method for facial morphology [14], it is assumed that the diagnostic value of facial assessment to detect TMJ involvement can be increased.…”

Oral health and temporomandibular joint involvement of patient with juvenile idiopathic arthritis

“…Hastanın yaşı, şikayetleri ve TME tutulumu ile hastalığın aktivitesi göz önünde bulundurularak her bireye göre ayrı değerlendirilmesi önerilmiştir. 38 JIA'lı hastaların orofasiyal muayenesi için klinik uygulamada ve ileride yapılacak çalışmalar için standardize edilmiş veri toplamada kullanılmak üzere, uluslararası görüş birliği oluşturabilmek amacı ile öneriler geliştirmek üzere 2017 yılında bir makale yayınlanmıştır. Bu makalede; 1) tıbbi geçmiş, 2) orofasiyal semptomlar, 3) kas ve temporomandibular eklem fonksiyonu, 4) orofasiyal fonksiyon ve 5) dentofasiyal büyüme olmak üzere 5 alanı değerlendirmek için öneriler geliştirilmiştir.…”

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

“…Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders including rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and spondyloarthropathies such as ankylosing spondylitis (AS) and psoriatic arthritis (PsA), leading to significant disability as well as impaired quality of life [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Up 98% of patients with RA (Franks, 1969;Syrjanen, 1985;Uotila, 1964; o'Connor 2017), 63% of PsA patients (Kononen, 1987;Lundberg and Ericson, 1967; Rasmussen and Bakke, 1982; o'Connor 2017), about 32% of those diagnosed with AS (Maes and Dihlmann, 1968;Resnick, 1974;Wenneberg, Hollender, and Kopp, 1983; o'Connor 2017), and up to 72% JIA (Niibo, 2016) will develop TMJ arthritis during the course of their disease, presenting with a variable clinical spectrum that range from asymptomatic to clinically significant arthritis characterized by severe pain, articular noises, mandibular deviation during maximum extrusion, joint stiffness, difficulties in opening the mouth [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”

“…The magnitude of TMJ involvement depends on the type of rheumatic pathology and seems to be related to disease activity and severity status [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Therefore, it is clearly that inflammator y parameters such as er ythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), as well as immune abnormalities including the level of rheumatoid factor (RF) and plasma tumour necrosis factorα (TNF-α) are related to the severity of TMJ disease, particularly in RA patients [1][2][3][4][5][6][7][8][9][10][11][12][13][14].…”