Physical Findings Associated With Active Temporomandibular Joint Inflammation in Children With Juvenile Idiopathic Arthritis

Abramowicz, Shelly; Susarla, Harlyn K.; Kim, Susan; Kaban, Leonard B.

doi:10.1016/j.joms.2013.04.009

Cited by 43 publications

(27 citation statements)

References 10 publications

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“…Oxidative stress was increased in JIA patients (Breda et al 2013;Lipinska et al 2015). On the other hand, JIA is the most common disease in pediatric rheumatology and characterized by chronically joint destruction and inflammation (Koos et al 2013;Abramowicz et al 2013). Fortunately, anti-oxidant and anti-inflammation properties of blueberry have been widely reported with fewer side effects (Kraujalyte et al 2015;Chiabrando and Giacalone 2015;Diaconeasa et al 2015;Kang et al 2015).…”

Section: Discussionmentioning

confidence: 98%

Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study

Zhong

Wang

Guo

et al. 2015

Tohoku J. Exp. Med.

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Juvenile idiopathic arthritis (JIA) is the most common arthritis in the adolescents under the age of 16. Etanercept, an inhibitor of tumor necrosis factor, is often used to treat JIA despite its significant side effects. Homeopathic remedies, such as blueberries, have anti-inflammatory properties with fewer unwanted effects and should be considered as a primary treatment. We aimed to explore the efficacy and safety of combination therapy of blueberry and etanercept for JIA. Two hundred and one JIA patients were selected, and randomly and evenly assigned to three groups: ETA (50 mg of etanercept twice weekly), ETABJ (matched etanercept and 50 ml blueberry juice daily) and ETAPJ (matched etanercept and placebo juice). The severity of JIA was measured using American College of Rheumatology scales (ACR) 20, 50 and 70. The levels of pro-inflammatory cytokines, interleukin-1 (IL1) alpha and IL1 beta, and interleukin-1 receptor antagonist (IL1RA) were measured by qRT-PCR and ELISA. After a 6-month follow-up, the ACR20, ACR50 and ACR70 in an ETABJ group were higher than those in other two groups (P < 0.05), suggesting clinically meaningful improvement in JIA. Meanwhile, the symptoms and side effects were reduced significantly or absent in an ETABJ group, including mental diseases, retrobulbar optic neuritis, gaining weight, infection, cutaneous vasculitis, diarrhea, uveitis and pancytopenia. Blueberries reduced the levels of IL1 alpha and beta, and increased the level of IL1RA. Thus, a combination therapy of blueberry and etanercept can reduce the severity of JIA and should be developed as a new method for JIA therapy.

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Section: Discussionmentioning

confidence: 98%

Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study

Zhong

Wang

Guo

et al. 2015

Tohoku J. Exp. Med.

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“…We did not ask what items of the history and physical were assessed. A recent study showed that decreased mouth opening and lateral protrusion of the chin seems to be most sensitive clinically [9]. Applied questions for orofacial symptoms have not been previously assessed [10].…”

Section: Discussionmentioning

confidence: 99%

Results of a multinational survey regarding the diagnosis and treatment of temporomandibular joint involvement in juvenile idiopathic arthritis

Foeldvari¹,

Tzaribachev²,

Cron

2014

Pediatr Rheumatol

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BackgroundTemporomandibular joint (TMJ) involvement occurs in up to 80% of patients with juvenile idiopathic arthritis (JIA). Currently there are no standardized procedures regarding diagnosis and treatment of this common complication of JIA. The aim of the study was to assess the current clinical practices in many countries regarding diagnosis and treatment of TMJ involvement in JIA. Pediatric rheumatologists were asked to fill out a survey with 8 items regarding diagnosis and treatment of TMJ involvement. The survey was distributed over the worldwide pediatric rheumatology electronic list-serve. Data was collected in an Excel spread sheet and analyzed using Excel software.FindingsEighty-seven centers responded to the survey between December 2009 and April 2010. All responding centers were actively screening for TMJ involvement. All centers were screening by physical exam, 85 (97%) by history, and 2 (3%) by imaging. Seventy-seven (88%) centers were screening at the first visit and 76 (87%) at each follow-up visit. If imaging was requested, 77% of the centers reported that they asked for MRI, 10% for ultrasound, 9% for CT and 33% for X-ray. The first line treatment of TMJ arthritis was a non-biologic DMARD in 36%, an NSAID in 33%, an intraarticular corticosteroid injection in 26%, and an anti-TNF agent in 5%. Overall, 57 (65%) of the centers were using intraarticular corticosteroid injections as treatment.ConclusionsTMJ arthritis is common among children with JIA. This survey shows that a wide array of diagnostic and therapeutic approaches is being employed for TMJ disease in 87 international centers. Due to this lack of agreement in how to diagnose and treat this JIA complication, we believe that an expert opinion/consensus statement regarding TMJ arthritis in JIA will likely benefit patients worldwide.

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“…[18][19][20][21][22] Throughout the literature, several other clinical signs have been associated with TMJ arthritis ( Table 2).…”

Section: Clinical Signsmentioning

confidence: 99%

“…[18][19][20][21][22] Mouth-opening capacity is also the clinical outcome measure most consistently used in studies related to TMJ arthritis diagnosis and management. 23 Such studies have used mouth-opening capacity as an indirect outcome variable reflecting the current functional status of the TMJ, with increased post-treatment mouth-opening capacity interpreted as a treatment-induced improvement in TMJ function.…”

Section: Clinical Signsmentioning

confidence: 99%

“…Asymmetric mandibular position at maximal opening position, in relation to the facial vertical midline, may indicate TMJ arthritis in the side of deviation. 18,21,22 Another clinical finding associated with TMJ involvement is a lack of condylar translation, such that the joint only displays a rotational movement during mouth opening. 20,22 Limited association between MRI and orofacial signs/symptoms…”

Section: Clinical Signsmentioning

confidence: 99%

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Clinical craniofacial examination of patients with juvenile idiopathic arthritis

Stoustrup

Koos²

2015

Seminars in Orthodontics

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Physical Findings Associated With Active Temporomandibular Joint Inflammation in Children With Juvenile Idiopathic Arthritis

Cited by 43 publications

References 10 publications

Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study

Blueberry Improves the Therapeutic Effect of Etanercept on Patients with Juvenile Idiopathic Arthritis: Phase III Study

Results of a multinational survey regarding the diagnosis and treatment of temporomandibular joint involvement in juvenile idiopathic arthritis

Clinical craniofacial examination of patients with juvenile idiopathic arthritis

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