Risk Factors for Intraarticular Heterotopic Bone Formation in the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Stoll, Matthew L.; Amin, Dina; Powell, Kathlyn; Poholek, Catherine H.; Strait, Rachel; Aban, Inmaculada; Beukelman, Timothy; Young, Daniel W.; Cron, Randy Q.; Waite, Peter D.

doi:10.3899/jrheum.171306

Cited by 31 publications

(15 citation statements)

References 27 publications

(47 reference statements)

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“…IAGCs may alleviate joint symptoms and help restore function. This recommendation is conditional, as there have been unique TMJ‐specific serious adverse events, including heterotopic ossification and impaired growth (52–55). Therefore, IAGCs for TMJ arthritis should be used sparingly for symptomatic children, preferably those who are skeletally mature (53–56).…”

Section: Results/recommendationsmentioning

confidence: 99%

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Onel

Horton

Lovell

et al. 2022

Arthritis Care & Research

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Objective To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. Methods We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. Results Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. Conclusion This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision‐making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision‐making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.

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Section: Results/recommendationsmentioning

confidence: 99%

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Onel

Horton

Lovell

et al. 2022

Arthritis Care & Research

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“…In the present issue of The Journal, Stoll, et al 15 found that 14% developed HBF after TMJ IACI in a retrospective study of 238 children. In this study, nonresponders to TMJ IACI received intraarticular TMJ injections with infliximab.…”

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confidence: 76%

Management of Temporomandibular Joint Arthritis in JIA: Tradition-based or Evidence-based?

2018

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“…Some drugs, such as corticosteroids, when administered by intra-articular injection, are also possible causes of heterotopic TMJ calcifications. 26,27 It is worth noting that the majority of previous studies involving TMJ calcifications were limited to cases of synovial chondromatosis. It was not an aim of the present study to determine the causal factors and/or to diagnose the TMJ calcifications precisely, since the data available were limited to the CBCT images, with no access to any additional information or clinical examination data.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations

et al. 2020

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Purpose: The purpose of this study was to use cone-beam computed tomography (CBCT) images to determine the prevalence of calcifications in the temporomandibular joint (TMJ) and to evaluate any associations between the presence of such calcifications and degenerative bone alterations of the TMJ, sex, or age. Materials and Methods: In this retrospective study, 1,058 CBCT exams were analyzed, and data regarding the presence and quantity of calcifications, the affected side, any degenerative alterations of the condyle, sex, and age were collected. To evaluate associations between the presence of calcifications and sex or age, the Fisher exact test or the Spearman correlation coefficient, respectively, was used. To assess the association between the presence of calcifications and joint bone alterations, the chi-square and Fisher exact tests were used. The significance level adopted was 5% (P<0.05). Results: Twenty-eight patients (2.7%) presented with TMJ calcifications, including 23 women (82.1%) and 5 men (17.9%). Significant correlations were found between the presence of calcifications and age (P<0.05) and between the presence of calcifications and the presence of condylar alterations (P<0.05), with 73.2% of patients with bone alterations having TMJ calcifications. Conclusion: It may be concluded that, although rare (with a prevalence of only 2.7%), intra-articular calcifications are associated with both degenerative bone alterations and age.

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Risk Factors for Intraarticular Heterotopic Bone Formation in the Temporomandibular Joint in Juvenile Idiopathic Arthritis

Cited by 31 publications

References 27 publications

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis

Management of Temporomandibular Joint Arthritis in JIA: Tradition-based or Evidence-based?

Intra-articular calcifications of the temporomandibular joint and associations with degenerative bone alterations

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