Mandibular condyle lesions related to age at onset and subtypes of juvenile rheumatoid arthritis in 15‐year‐old children

Abstract

The severity of lesions in the temporomandibular joint (TMJ) area and their association with age at onset, the various forms of juvenile rheumatoid arthritis (JRA), and certain serologic tests for rheumatoid factor (RF), antinuclear antibodies (ANA), and human leukocyte antigen (HLA)‐B27 were determined in 15‐yr‐old children. The series comprised 121 JRA children, 78 girls and 43 boys, in whom an analysis had recently been made of the relation of TMJ lesions to jaw movement and occlusal status. The mean age at onset was 7.3 yr, the girls contracting JRA earlier than the boys. Also, the girls with lesions in the TMJ area were significantly younger than those with no lesions. TMJ abnormalities were found in 50% of cases with a pauciarticular or systemic onset, but in 72% of those representing the polyarticular subtype. Flattened condyles and grave lesions were equally represented in all subgroups and in both sexes. A crossover from onset type to present diagnosis was found in 30% of the cases, mostly from pauciarticular to polyarthritis, which also increased the risk of TMJ lesions from 50 to 60%. RF, ANA, or HLA‐B27 alone did not seem to be associated with a risk of TMJ abnormalities. Maximal opening capacity is more restricted in patients with early onset or a polyarticular mode of JRA. Since the TMJ is affected in more than half of JRA children, regular measurements of maximal movements of the mandible or roentgenologic examinations of the TMJ are essential for their optimal treatment.

Size, shape and age-related changes of the mandibular condyle during childhood

“…The temporomandibular joint (TMJ) is frequently subject to inflammatory disorders in children especially within the disease pattern of juvenile idiopathic arthritis (JIA) [1][2][3][4][5][6][7][8][9]. Arthritis of the TMJ, if not detected early and treated properly, may lead to bone destruction and osseous deformation of the mandibular condyle resulting in growth disturbances and dysmorphic facial features [2; 10-12].…”

Juvenile idiopathic arthritis—and now?

“…International erkranken jährlich zwischen 2 und 20/100.000 Kinder und Jugendliche unter 16 Jahren (Quelle: Internetpräsenz GKJR, Gesellschaft für Kinder-und Jugendrheumatologie, Stand 11/2010; http://www.agkjr.de/jiahaeufigkeit.html). Etliche Studien konnten zeigen, dass 38−72% der jungen JIA-Patienten bereits einen klinisch nachweisbaren Befall eines oder beider Kiefergelenke haben [19,23,31,32]. Diese arthritische Schädigung der Kondylen kann Auswirkungen auf die Unterkieferentwicklung haben, weshalb etwa 30% der JIA-Kinder eine Mikrognathie zeigen, während eine Malokklusion im Allgemeinen rund 70% dieser Patienten betrifft.…”

“…The literature contains contradictory information on the prevalence of temporomandibular joint involvement in JIA. While Cannizzaro et al [7] observed that patients with a pauciarticular type were more frequently affected by temporomandibular joint changes than those with other subtypes, other groups of authors [16,19,29,35,44] found that patients with polyarticular manifestations were significantly more often affected than children with an pauci- von Bremen J, Ruf S Craniofacial modifications by JIA [19] could not find an association between HLA-B27 and arthritic temporomandibular joint involvement, Cannizzaro et al [7] and Pedersen [35] found that HLA-B27-positive patients had significantly less pathological TMJ changes than patients without HLA-B27. This inconsistency clearly illustrates that not only the JIA subtype needs to be defined, but also a differVeränderungen betroffen ist, kann aufgrund der uneinheitlichen und äußerst unübersichtlichen Datenlage nicht geklärt werden.…”

“…Since some authors [7,16,19,29,35,44] demonstrated that not all JIA subtypes are equally affected by pathological wurden [9,10,11,15]. Da aber in zwei davon [10,11] nicht spezifiziert war, welche Art von Therapie durchgeführt wurde, ist vollkommen offen, ob diese einen Einfluss auf die Gesichtsschä-delmorphologie gehabt haben könnte ( Tabelle 7).…”

“…Worldwide, between 2 and 20 per 100,000 children and adolescents under that age are affected (source: website of the "Gesellschaft für Kinder-und Jugendrheumatologie" [GKJR, Society for Pediatric and Adolescent Rheumatology], status 11/2010; http://www.agkjr.de/jiahaeufigkeit.html). Several studies have shown that 38-72% of the JIA patients already have clinically detectable lesions in one or both temporomandibular joints (TMJ) [19,23,31,32]. Such an arthritic damage of the condyles can affect mandibular development.…”