Magnetic Resonance Imaging Followup of Temporomandibular Joint Inflammation, Deformation, and Mandibular Growth in Juvenile Idiopathic Arthritis Patients Receiving Systemic Treatment

Abstract

Objective.To investigate the course of temporomandibular joint (TMJ) inflammation, osseous deformation, and mandibular ramus growth in children with juvenile idiopathic arthritis (JIA) during systemic therapy.Methods.Longitudinal study of 38 consecutive patients with JIA (29 female, median age 9.0 yrs, interquartile range 6.2–10.7 yrs) receiving systemic therapy with TMJ involvement, with 2 TMJ magnetic resonance imaging (MRI) examinations ≥ 2 years apart and no TMJ corticosteroid injection. Clinical and MRI findings were compared between initial and followup examinations and between TMJ with and without active inflammation at baseline.Results.Over a median period of 3.6 years (range, 2.0–8.7 yrs), MRI grade of TMJ inflammation improved (p = 0.009) and overall osseous deformity tended to become less severe (p = 0.114). In TMJ with arthritis at baseline (46 TMJ), both the grades of inflammation (p < 0.001) and deformity (p = 0.011) improved. In TMJ with no arthritis at baseline (30 TMJ), the frequency and grade of condylar deformation remained stable. Mandibular ramus growth rates were not significantly different between TMJ with and without arthritis at baseline (1.3 mm/yr vs 1.5 mm/yr, p = 0.273), and were not correlated with the degree of inflammation at baseline or followup. The frequency of facial asymmetry tended to be lower at followup than at initial examination (24% vs 45%, p = 0.056).Conclusion.Our results suggest that systemic treatment of TMJ arthritis in children with JIA decreases the degree of inflammation seen on MRI, preserves osseous TMJ morphology, and maintains normal mandibular ramus growth.

Temporomandibular joint magnetic resonance imaging findings in adolescents with anterior disk displacement compared to those with juvenile idiopathic arthritis

“…As TMJ involvement may be clinically inapparent, detection of early TMJ arthritis relies on contrast‐enhanced MRI showing signs of inflammation . The goal of treatment in JIA focuses on the prompt control of active inflammation with the hope to prevent further joint damage and preserve normal mandibular growth . With the increasing awareness of potential TMJ involvement in JIA, children and adolescents with TMJ symptoms or condylar deformities are frequently referred for MRI with the question of possible TMJ involvement by JIA.…”

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study

“…We could not evaluate the effects on mandibular growth since the patients were mostly fully grown at the time the injection was performed. Even if systemic treatment alone seems to improve TMJ arthritis in most children with JIA in a retrospective study [15], our prospective pilot study may point to a single steroid injection as a treatment option for severe symptoms of TMJ-arthritis unresponsive to systemic treatment in skeletally mature individuals.…”

“…Both systemic and local treatments have been used in patients with TMJ arthritis [13][14][15]. Several observational studies report short-term effect of intraarticular corticosteroid injections (IACs) to the TMJ on pain and maximal incisal opening (MIO) [16][17][18][19][20][21].…”

Improving treatment of the temporomandibular joint in juvenile idiopathic arthritis: let’s face it

“…Management of TMJ involvement and the associated facial conditions in the JIA patient include systemic and local administrated drug therapy, orthopedic devices (oral splints), facial physiotherapy, and surgical intervention. Active TMJ arthritis warrants treatment with immunosuppressive medications often prescribed in JIA and can consist of disease modifying medication such as methotrexate and/or biological therapy [15]. Some providers advocate that active TMJ arthritis should be treated aggressively with biologics, alike sacroillitis, as many children develop refractory TMJ inflammation.…”