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

Abstract

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.

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

“…Clinical assessment of limited mouth-opening capacity, mandibular deviation during mouth opening, and reduced condylar translation is strongly associated with TMJ involvement on imaging in a number of studies [ 43 , 44 ]. Clinical predictors of TMJ involvement in studies using conventional radiographic methods and MRI are young age at onset (<4 years), long disease duration, systemic or polyarticular disease subtype, and extended disease course [ 26 , 45 , 46 ]. Many clinicians still use X-ray for imaging during early phases of TMJ arthritis.…”

“…Many clinicians still use X-ray for imaging during early phases of TMJ arthritis. However, during early phases, OPTG has poor sensitivity, and it appears to be better suited for studying TMJ bony changes later in the disease course [ 45 ].…”

“…To achieve these targets, propagation of multidisciplinary expertise in dentistry and networking of scientific and dental/medical centers is mandatory, in order to shift the paradigm from reactive medical services to predictive, preventive, and personalized medicine in dentistry [ 45 ].…”

Systemic and intra-articular anti-inflammatory therapy of temporomandibular joint arthritis in children with juvenile idiopathic arthritis

“…1 Indeed, several studies documenting the frequency of involved joints in JIA patients have completely excluded the TMJ, 7,8 and there is enormous variation among centers regarding the perceived frequency of TMJ arthritis among JIA patients. 9 However, centers that perform routine screening of TMJ arthritis by magnetic resonance imaging (MRI) report frequencies of 40-80%. [10][11][12] Although symptoms of TMJ involvement and abnormal physical exam findings (e.g., jaw deviation and small oral aperture) appear to have a high predictive value in identifying TMJ arthritis, 11,12 the absence of these findings is by no means reassuring, necessitating MRI screening to identify asymptomatic cases.…”

Das Kiefergelenk bei juveniler idiopathischer Arthritis (JIA) – immer noch vergessen?

“…77 % der beteiligten Zentren verifizieren die klinischen Befunde durch MRT, 10 % durch Ultraschall, 9 % durch CT und 33 % durch Röntgenaufnahmen. Somit präsentiert die Umfrage ein weites Spektrum von diagnostischen und therapeutischen Konzepten bei JIA mit Kiefergelenkbeteiligung und die Autoren fordern eine international konsentierte Expertenempfehlung zum Wohle der betroffenen Kinder und Jugendlichen [1].…”