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Carlsson AD, Wahlund K, Ghafouri B, Kindgren E, Frodlund M, Salé H, Klintström E, Johansson CS, Alstergren P. Parotid saliva and blood biomarkers in juvenile idiopathic arthritis in relation to temporomandibular joint magnetic resonance imaging findings. J Oral Rehabil 2024. [PMID: 39007294 DOI: 10.1111/joor.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) often affects the temporomandibular joint (TMJ) caused by an abnormal immune system that includes overactive inflammatory processes. Salivary biomarkers may be a powerful tool that can help establishing diagnosis, prognosis and monitor disease progress. OBJECTIVE The objective was to investigate biomarkers in parotid saliva and blood plasma in relation to temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings in patients with JIA and healthy individuals. METHODS Forty-five children aged 6 to 16 years with JIA and 16 healthy age- and sex-matched controls were included. Unstimulated parotid saliva samples and venous blood were collected. Biochemical analyses were performed for the cytokine biomarkers. The participants underwent MR imaging of the TMJs, where changes in the inflammatory and the damage domains were assessed. RESULTS In the JIA patients, lower concentrations of IL-6R and gp130 were found in parotid saliva than in plasma. Higher concentrations of IL-6 were found in parotid saliva than in plasma. IL-6, IL-6R and gp130 in parotid saliva explained the presence of bone marrow oedema and effusion in the JIA patients. CONCLUSIONS This study suggests that the IL-6 family in parotid saliva is associated with TMJ bone marrow oedema and effusion in patients with JIA, suggesting that IL-6 has promising properties as a parotid saliva biomarker for TMJ inflammatory activity.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Bijar Ghafouri
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skövde Hospital, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Salé
- Department of Neuroradiology, Center of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carin Starkhammar Johansson
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Costello A, Twilt M, Lerman MA. Provider assessment of the temporomandibular joint in Juvenile idiopathic arthritis: a retrospective analysis from the CARRA database. Pediatr Rheumatol Online J 2024; 22:41. [PMID: 38589909 PMCID: PMC11000332 DOI: 10.1186/s12969-024-00968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) involvement is an often underrecognized complication of juvenile idiopathic arthritis (JIA) that can cause decreased mandibular growth, altered facial morphology, and orofacial pain. It is estimated that the TMJ is affected in 30-45% of children with JIA. Standardized physical examination and imaging evaluations are important in accurately assessing active TMJ arthritis and sequalae. Little is known about the rate at which providers evaluate TMJ involvement in their clinical practice. METHODS Data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Data fields related to assessment for TMJ arthritis were added in 2019. Patients were included in the study if they had a diagnosis of JIA and had data recorded between January 2020 and August 2021. Standard descriptive statistics were used to describe demographic and clinical features. RESULTS A total of 17,761 visits were reviewed for a total of 7473 patients with JIA. A total of 52.7% of patients had maximal mouth opening (MMO) recorded as finger breadths or total incisal distance (TID). Only 8% had TID measured. A total of 5.0% had MRI with contrast performed. A total of 939 patients had a diagnosis of TMJ arthritis. Of these, 28.5% had an MRI documented, 83% had an MMO documented, and 40% had TID measured. Few patient-level characteristics were statistically related to having MMO assessed. MRI was more likely to be obtained in older and in female patients. MMO was recorded at a given visit > 80% of the time at 17 sites, and it was recorded < 1% of the time at 8 sites. MRIs were infrequently performed at all sites, with 27 sites having no MRIs obtained and only 7 sites having an MRI obtained at > 10% of visits. CONCLUSIONS MMO is not consistently measured in patients with JIA, and it is rarely measured quantitatively. Similarly, TMJ MRIs are rarely obtained in patients with JIA. Site of care is more associated with TMJ assessments than patient-level characteristics. These data suggest that provider education is needed to improve the assessment of the TMJ in patients with JIA to enable earlier recognition and prevent long-term complications.
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Affiliation(s)
- Anna Costello
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Marinka Twilt
- Department of Pediatrics, Division of Rheumatology, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Melissa A Lerman
- Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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Collin M, Christidis N, Hagelberg S, Arvidsson LZ, Larheim TA, Ernberg M, Hedenberg-Magnusson B. Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study. Sci Rep 2024; 14:5512. [PMID: 38448491 PMCID: PMC10917773 DOI: 10.1038/s41598-024-56174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/03/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to clinically evaluate temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) and the ability to identify and/or predict development of TMJ-deformities over time using cone beam computed tomography (CBCT). The predictive value of self-reported TMJ pain was also assessed. A prospective longitudinal cohort study comprising 54 children with JIA, 39 girls and 15 boys, was performed. All children had active disease at baseline, 50% with the subtype oligoarthritis. Repeated clinical orofacial and CBCT examinations were performed over a two-year period. At baseline, 39% had radiographic TMJ deformities (24% unilateral, 15% bilateral), at 2-year follow-up, 42% (p > 0.05). Both progressing and improving TMJ deformities were observed. An association was found between TMJ-deformities and self-reported TMJ pain at baseline (p = 0.01). Maximum unassisted mouth opening (MUO) was smaller for children with TMJ-deformities (p < 0.05). The prevalence of palpatory muscle pain was high (48-59%) but not predictive of development of TMJ-deformities. TMJ noises increased over time and crepitations were associated with TMJ-deformities (p < 0.05). In conclusion, in children with JIA, self-reported TMJ pain and dysfunction were common and predictive of TMJ deformities. TMJ deformities were associated with smaller MUO and palpatory TMJ pain as well as crepitations. Trial registration. ClinicalTrials.gov Protocol id: 2010/2089-31/2.
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Affiliation(s)
- Malin Collin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden.
- Department of Orofacial Pain and Jaw Function, Folktandvården, Sörmland AB, Mälarsjukhuset, 611 32, Nyköping, Sweden.
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
| | - Stefan Hagelberg
- Department of Women's and Children's Health, Karolinska Institute, Karolinska University Hospital, 17176, Stockholm, Sweden
| | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
| | - Britt Hedenberg-Magnusson
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, 141 04, Huddinge, Sweden
- Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms Län AB, 11382, Stockholm, Sweden
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Dimitrijevic Carlsson A, Wahlund K, Kindgren E, Frodlund M, Alstergren P. Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study. Pediatr Rheumatol Online J 2024; 22:30. [PMID: 38409027 PMCID: PMC10898012 DOI: 10.1186/s12969-024-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Stress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA. METHODS This is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors. RESULTS Change in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function. CONCLUSIONS This study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
- Centre for Oral Rehabilitation, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden.
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Tonni I, Fossati G, Garo ML, Piancino MG, Cattalini M, Visconti L, Borghesi A. Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width. Oral Radiol 2023; 39:750-758. [PMID: 37400736 PMCID: PMC10504125 DOI: 10.1007/s11282-023-00696-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES This study aimed to compare the performance of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in assessing the Lateral Periarticular Space (LPAS) of Temporomandibular Joints (TMJs) in patients with Juvenile Idiopathic Arthritis (JIA). METHODS The LPAS width was evaluated in two different patient groups. In the JIA group, including 29 children (13 ± 2.8 years) with JIA, the LPAS width was measured with both MRI and US. In the healthy group, including 28 healthy children (12.6 ± 2.5 years), the LPAS width was measured only with US. Comparisons of LPAS width based on patient groups and TMJ contrast enhancement in MRI were evaluated by applying the Mann-Whitney U test. Correlation and agreement between MRI and US measurements in JIA group were tested using Spearman rank correlation and Bland-Altman method. RESULTS The LPAS width was significantly greater in the JIA group than in the healthy group. In the JIA group, the LPAS width was significantly greater in TMJs with moderate/severe enhancement than those with mild enhancement. A positive significant correlation between MRI and US measurements of LPAS width was found in the JIA group. In the same group, Bland-Altman method showed a good level of agreement between MRI and US measurements. CONCLUSION Although, US cannot replace MRI in the evaluation of TMJ in patients with JIA, US could be used as a supplementary imaging method to MRI in assessing the TMJ disease.
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Affiliation(s)
- Ingrid Tonni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy.
| | - Giulia Fossati
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Luisa Garo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Grazia Piancino
- Department of Surgical Sciences, C.I.R. Dental School, Orthodontic Division, Dental School, University of Turin-Italy, Via Nizza 230, 10126, Turin, Italy
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Visconti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
- Operational Unit 2nd Diagnostic Radiology, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
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Lerman MA. Opening Wide: Advances in Understanding Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2023; 75:1509-1511. [PMID: 37096578 DOI: 10.1002/art.42539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Melissa A Lerman
- Division of Rheumatology, The Children's Hospital of Philadelphia, and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Glerup M, Tagkli A, Küseler A, Christensen AE, Verna C, Bilgrau AE, Nørholt SE, Herlin T, Pedersen TK, Stoustrup P. Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition: A Population-Based Cohort Study. Arthritis Rheumatol 2023; 75:1658-1667. [PMID: 36806745 DOI: 10.1002/art.42481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/29/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To estimate the cumulative incidences of orofacial conditions related to temporomandibular joint (TMJ) juvenile idiopathic arthritis (JIA) between diagnosis in childhood to transition into adult care, and to identify features in JIA associated with TMJ involvement. METHODS A population-based cohort analysis was conducted of patients with JIA involving longitudinal data on orofacial health from 2000 to 2018. Regardless of TMJ status, the patients were referred to the Regional Specialist Craniofacial Clinic of Western Denmark for routine orofacial examinations. Data collection included information about disease-specific background characteristics, TMJ involvement, JIA-induced dentofacial deformity, and orofacial symptoms and dysfunction. RESULTS A total of 613 patients were followed up with a mean clinical TMJ observation time of 4.0 years. From JIA onset to transition into adult care, the cumulative incidence of patients with JIA involvement of the TMJ was 30.1%. Furthermore, 20.6% of the cohort had developed arthritis-induced dentofacial deformity. A substantial proportion of the cohort experienced several events with orofacial symptoms (23.5%) and dentofacial dysfunction (52%). Young age at diagnosis (<9 years), female gender, and antinuclear antibody positivity were significantly associated with TMJ involvement. CONCLUSION Orofacial signs and symptoms were frequent findings in children and adolescents with JIA. TMJ involvement was seen in 30.1% of the cohort; and 20.6% of the total cohort developed JIA-related dentofacial deformity before transition into adult care. This is the first population-based study in the era of available biologic treatments to document these frequent orofacial complications in children with JIA.
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Affiliation(s)
- Mia Glerup
- Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, UZB University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Anders E Bilgrau
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, and Section of Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Troels Herlin
- Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas K Pedersen
- Section of Orthodontics, Aarhus University, and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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Twilt M, Stoustrup P, Rumsey D. Challenges in treating juvenile idiopathic arthritis. Curr Opin Rheumatol 2023; Publish Ahead of Print:00002281-990000000-00060. [PMID: 37339528 DOI: 10.1097/bor.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE OF REVIEW Juvenile idiopathic arthritis (JIA) diagnosis and classification is currently still based on clinical presentation and general laboratory tests. Some joints such as the temporomandibular joint (TMJ) and sacroiliac (SI) are hard to assess and define as actively inflamed based on clinical examination. This review addresses these difficult to assess joints and provides the latest evidence for diagnosis and treatment. RECENT FINDINGS Recommendations on clinical examination and radiological examination are available. Recent 2021 ACR recommendations were made for TMJ arthritis and in 2019 for sacroiliitis. SUMMARY New evidence to guide clinical suspicion and need for further investigations are available for these hard to assess joints. These guidelines will help healthcare providers in diagnosis and treatment assessment.
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Affiliation(s)
- Marinka Twilt
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Peter Stoustrup
- Section of Orthodontics, Department of Dentistry, Aarhus University, Aarhus, Denmark
| | - Dax Rumsey
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Artamonov AK, Kaneva MA, Gordeeva NA, Sorokina LS, Kostik MM. Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: The Results from a Retrospective Cohort Tertial Center Study. Life (Basel) 2023; 13:life13051164. [PMID: 37240809 DOI: 10.3390/life13051164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Our study aimed to evaluate the clinical and laboratory features of juvenile idiopathic arthritis (JIA) children with temporomandibular joint (TMJ) arthritis. In the retrospective cohort study, we analyzed data of 753 patients with JIA aged 2-17 years, depending on TMJ arthritis or not. TMJ arthritis can to be diagnosed in the presence of at least two of the following clinical signs of inflammation: pain in TMJ, jaw opening limitation, jaw opening deviation, and micrognathia. We compared clinical, laboratory, and treatment features in JIA patients depending on the involvement of TMJ. TMJ arthritis was detected in 43 (5.7%) of our patients and associated with a longer course of the disease, polyarticular JIA category, treatment with systemic corticosteroids, and longer achievement of the remission and involvement of cervical spine, hip, and shoulder. Active joints >8 (OR = 14.9, p = 0.0000001), delayed remission >7 years (OR = 3.1; p = 0.0004), delayed hip involvement (OR = 4.6; p = 0.041), hip osteoarthritis (OR = 4.0; p = 0.014), cervical spine arthritis (OR = 10.3, p = 0.000001), and corticosteroid treatment (OR = 2.3, p = 0.0007) were associated with TMJ involvement. Patients with TMJ arthritis require more biologics (OR = 3.2, p = 0.0006, HR = 2.4, p = 0.005) and have decreased probability of remission achievement (p = 0.014). Consequently, TMJ arthritis was associated with a severe disease course. Early biologic treatment and corticosteroid avoidance might decrease TMJ involvement.
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Affiliation(s)
- Artem K Artamonov
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, 194100 Saint-Petersburg, Russia
| | - Maria A Kaneva
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, 194100 Saint-Petersburg, Russia
| | - Natalia A Gordeeva
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, 194100 Saint-Petersburg, Russia
- Pediatric Rheumatology, Saint-Petersburg Children's Hospital #2, n.a. Saint Mary Magdalene, 199053 Saint-Petersburg, Russia
| | - Lubov S Sorokina
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, 194100 Saint-Petersburg, Russia
| | - Mikhail M Kostik
- Hospital Pediatry, Saint-Petersburg State Pediatric Medical University, 194100 Saint-Petersburg, Russia
- Laboratory of Autoimmune and Autoinflammatory Diseases, Almazov National Medical Research Centre, 197341 Saint-Petersburg, Russia
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Ferrazzo KL, Thomas A, Danesi CC, Marquezan M, Ferrazzo VA. Diagnosis of juvenile idiopathic arthritis with asymptomatic involvement of the temporomandibular joint: A case report. SPECIAL CARE IN DENTISTRY 2023; 43:267-275. [PMID: 35830626 DOI: 10.1111/scd.12756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a broad term that describes a group of heterogeneous rheumatologic diseases, mainly characterized by inflammation in the joints of children and young people up to 16 years of age. Its etiology is still not well understood and the diagnosis, essentially clinical, begins with the exclusion of other joint diseases. When the disease affects the temporomandibular joint, diagnosis is a challenge, as many patients are asymptomatic. The objective of this paper is to present a case of JIA with severe involvement of the temporomandibular joint and to discuss the clinical, radiographic, laboratory findings and the importance of early diagnosis. The lack of diagnosis of active arthritis in the temporomandibular joint in patients with JIA can cause irreversible effects such as micrognathia, malocclusion and reduced maximum mouth opening. Early diagnosis of temporomandibular joint involvement in JIA is important and needs to be investigated early in the clinical manifestation of systemic disease. Laboratory tests and clinical history are important to define treatment and prognosis, but not to predict temporomandibular joint arthritis. Imaging exams are important diagnostic tools to identify morphological changes in soft and hard tissues of the temporomandibular joint.
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Affiliation(s)
- Kívia Linhares Ferrazzo
- Department of Pathology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Alexander Thomas
- Department of Pathology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Cristiane Cademartori Danesi
- Department of Pathology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Mariana Marquezan
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Vilmar Antonio Ferrazzo
- Department of Stomatology, School of Dentistry, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Augdal TA, Angenete OW, Shi XQ, Säll M, Fischer JM, Nordal E, Rosendahl K. Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system. BMC Oral Health 2023; 23:12. [PMID: 36627622 PMCID: PMC9830735 DOI: 10.1186/s12903-022-02701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT). METHODS Imaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated independently by three experienced radiologists for intra- and interobserver agreement. Agreement of categorical variables was assessed by Fleiss', Cohen's simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman. RESULTS "Overall impression of TMJ deformity" showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69-0.92), and substantial interobserver agreement (Fleiss' kappa 0.70 (0.61-0.78)). Moreover, both "flattening" and "irregularities" of the eminence/fossa and condyle performed well, with intra- and interobserver agreements of 0.66-0.82 and 0.55-0.76, respectively. "Reduced condylar volume" and "continuity" of the fossa/eminence had moderate intra- and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean. CONCLUSIONS We propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.
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Affiliation(s)
- Thomas A. Augdal
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar W. Angenete
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Institute for Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xie-Qi Shi
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.32995.340000 0000 9961 9487Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Mats Säll
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Johannes M. Fischer
- grid.7914.b0000 0004 1936 7443Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway ,grid.412244.50000 0004 4689 5540Department of Paediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- grid.412244.50000 0004 4689 5540Section of Paediatric Radiology, University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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12
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Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, Koos B, Verna C, Nordal EB, Granquist EJ, Halbig JM, Kristensen KD, Kaban LB, Arvidsson LZ, Spiegel L, Stoll ML, Lerman MA, Glerup M, Defabianis P, Frid P, Alstergren P, Cron RQ, Ringold S, Nørholt SE, Peltomaki T, Larheim TA, Herlin T, Peacock ZS, Kellenberger CJ, Twilt M. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75:4-14. [PMID: 36041065 PMCID: PMC10100353 DOI: 10.1002/art.42338] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.
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Affiliation(s)
| | - Cory M. Resnick
- Department of Plastic and Oral SurgeryBoston Children's HospitalBostonMassachusetts
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and PediatricsEmory University School of MedicineAtlantaGeorgia
| | - Thomas K. Pedersen
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | | | - Annelise Küseler
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Bernd Koos
- Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
| | - Carlalberta Verna
- Department of Pediatric Oral Health and OrthodonticsUZB University Center for Dentistry Basel, University of BaselBaselSwitzerland
| | - Ellen B. Nordal
- Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Eric J. Granquist
- Department of Oral and Maxillofacial Surgery, School of Dental MedicineUniversity of PennsylvaniaPhiladelphia
| | - Josefine Mareile Halbig
- The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | | | - Leonard B. Kaban
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | - Linda Z. Arvidsson
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Lynn Spiegel
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Melissa A. Lerman
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvania
| | - Mia Glerup
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | | | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical DentistryUiT The Arctic University of NorwayTromsøNorway
| | - Per Alstergren
- Faculty of Odontology, Orofacial Pain UnitMalmö UniversityMalmöSweden
| | | | | | - Sven Erik Nørholt
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Timo Peltomaki
- Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University HospitalKuopioFinland
| | - Tore A. Larheim
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Troels Herlin
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | - Zachary S. Peacock
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | | | - Marinka Twilt
- Alberta Children's Hospital and University of CalgaryCalgaryAlbertaCanada
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13
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Fischer J, Halbig J, Augdal T, Angenete O, Stoustrup PB, Dahl Kristensen K, Slåttelid Skeie M, Tylleskär K, Rosén A, Shi X, Rosendahl K. Observer agreement of imaging measurements used for evaluation of dentofacial deformity in juvenile idiopathic arthritis. Dentomaxillofac Radiol 2022; 51:20210478. [PMID: 35466687 PMCID: PMC10043626 DOI: 10.1259/dmfr.20210478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the precision of imaging measures commonly used to assess mandibular morphology in children and adolescents with juvenile idiopathic arthritis (JIA). Secondly, to compare cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in the measurement of condylar height. METHODS Those included were children diagnosed with JIA during 2015-18 who had had an MRI, a CBCT of the temporomandibular joints (TMJs) and a lateral cephalogram (ceph) of the head within one month of each other. Agreement within and between observers and methods was examined using Bland-Altman mean-difference plots and 95% limits of agreement (LOA). A 95% LOA within 15% of the sample mean was considered acceptable. Minimal detectable change (MDC) within and between observers was estimated. RESULTS 90 patients (33 males) were included, with a mean age of 12.8 years. For MRI, intra- and interobserver 95% LOA were relatively narrow for total mandibular length: 9.6% of the sample mean. For CBCT, condylar height, both intra- and interobserver 95% LOA were wide: 16.0 and 28.4% of the sample mean, respectively. For ceph, both intra- and interobserver 95% LOA were narrow for the SNA-angle and gonion angle: 5.9 and 8% of the sample mean, and 6.2 and 6.8%, respectively. CONCLUSIONS We have identified a set of precise measurements for facial morphology assessments in JIA, including one MRI-based (total mandibular length), one CBCT-based (condylar height), and three ceph-based. Condylar height was higher for MRI than for CBCT; however, the measurement was too imprecise for clinical use. MDC was also determined for a series of measurements.
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Affiliation(s)
- Johannes Fischer
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Josefine Halbig
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway
| | | | | | | | | | | | - Karin Tylleskär
- The Children’s Clinic at Haukeland University Hospital, Bergen, Norway
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14
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Role of Ultrasound Evaluation of Temporomandibular Joint in Juvenile Idiopathic Arthritis: A Systematic Review. CHILDREN 2022; 9:children9081254. [PMID: 36010144 PMCID: PMC9406954 DOI: 10.3390/children9081254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022]
Abstract
Background: Juvenile idiopathic arthritis (JIA) is childhood’s most frequent chronic rheumatic disease. JIA is a broad term that includes all arthritides starting before 16 years, lasting at least six weeks, and of unknown cause. The temporomandibular joint (TMJ) could be involved in JIA both at onset and during the disease course. The presence of TMJ synovitis might severely impair dentofacial maturation in pediatric patients. The ultrasound (US) application to detect early signs of TMJ synovitis in children with JIA has provided contradictory results. We sought to assess the current role of TMJ US in JIA through a systematic literature review. Methods: The systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Results: The literature search found 345 records. After duplicates removal, 253 records were screened, 20 full-text articles were reviewed to assess their eligibility, and 7 of them were included in the qualitative analysis. Joint effusion was the most recorded parameter, followed by bony condylar abnormalities. Compared to contrast enhancement MRI, the capability to detect signs of active synovitis of TMJ by US is low, especially at the early stages. Conclusion: Understanding how US may help diagnose and manage children with JIA is advisable for several reasons. MRI cannot be frequently repeated, may need sedation, and is expensive. The constant technical improvement of US will undoubtedly allow for better evaluation of what, in the past, was not clear or not even captured by sonography. So far, the role of US in the assessment of TMJ involvement in JIA is indubitably secondary to the MRI. Even so, we think that a baseline MRI of TMJ and the repetition of the sonography over time might both help the interpretation of US images and intercept significative changes.
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15
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Cetrelli L, Bletsa A, Lundestad A, Gil EG, Fischer J, Halbig J, Frid P, Angenete O, Lillevoll I, Rosén A, Tylleskär KB, Luukko K, Nordal E, Åstrøm AN, Skeie MS, Feuerherm AJ, Sen A, Rygg M. Vitamin D, oral health, and disease characteristics in juvenile idiopathic arthritis: a multicenter cross-sectional study. BMC Oral Health 2022; 22:333. [PMID: 35941635 PMCID: PMC9361556 DOI: 10.1186/s12903-022-02349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Vitamin D deficiency has been associated with autoimmune diseases and oral health. Knowledge about the association between vitamin D status and oral conditions in JIA is limited. We aimed to investigate vitamin D status in a cohort of Norwegian children and adolescents with JIA and possible associations between serum vitamin D levels, clinical indicators of oral health, and JIA disease characteristics. Methods This multi-center, cross-sectional study, included individuals with JIA aged 4–16 years from three geographically spread regions in Norway. Demographic data, age at disease onset, disease duration, JIA category, disease status, medication, and vitamin D intake were registered. One blood sample per individual was analyzed for 25(OH) vitamin D, and the level of insufficiency was defined as < 50 nmol/L. A clinical oral examination was performed applying commonly used indices in epidemiological studies of dental caries, dental erosion, enamel defects, gingival bleeding, and oral hygiene. Serum vitamin D was used as exposure variable in multivariable regression analyses to estimate the associations between insufficient vitamin D level, JIA disease status, and oral conditions, with adjustments for age, sex, geographical region, BMI, seasonal blood sampling, and parental education. Results Among the 223 participants with JIA, 97.3% were Caucasians, 59.2% were girls, and median age was 12.6 years. Median disease duration was 4.6 years, and 44.4% had oligoarticular JIA. Mean serum vitamin D level was 61.4 nmol/L and 29.6% had insufficient levels. Vitamin D levels did not differ between sexes, but between regions, iso-BMI categories, age groups, and seasons for blood sampling. Insufficient vitamin D levels were associated with dentin caries (adjusted OR 2.89, 95% CI 1.43–5.86) and gingival bleeding (adjusted OR 2.36, 95% CI 1.10–5.01). No associations were found with active JIA disease or more severe disease characteristics. Conclusion In our study, nearly 30% had vitamin D insufficiency, with a particularly high prevalence among adolescents. Vitamin D insufficiency was associated with dentin caries and gingival bleeding, but not with JIA disease activity. These results point to the need for a multidisciplinary approach in the follow-up of children with JIA, including an increased focus on vitamin D status and oral health. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02349-1.
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Affiliation(s)
- Lena Cetrelli
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway. .,The Public Dental Health Service, Trøndelag County, Trondheim, Norway. .,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Athanasia Bletsa
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Anette Lundestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Elisabet Grut Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Johannes Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Josefine Halbig
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Medicine, The Arctic University of Norway, Tromsø (UiT), Norway
| | - Paula Frid
- Public Dental Health Service Competence Centre of Northern Norway (TkNN), Tromsø, Norway.,Department of Clinical Dentistry, The Arctic University of Norway, Tromsø (UiT), Norway.,Division of Oral and Maxillofacial Surgery, Department of Otorhinolaryngology, University Hospital North Norway, Tromsø, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olav Hospital HF, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid Lillevoll
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Annika Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karin B Tylleskär
- The Children's Clinic at Haukeland University Hospital, Bergen, Norway
| | - Keio Luukko
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ellen Nordal
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø (UiT), Norway.,Department of Pediatrics, University Hospital of Northern Norway, Tromsø, Norway
| | - Anne Nordrehaug Åstrøm
- Oral Health Centre of Expertise in Western Norway (TkV), Bergen, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Marit Slåttelid Skeie
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway.,Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Abhijit Sen
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway.,Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
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16
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Niu X, Moland J, Pedersen TK, Bilgrau AE, Cattaneo PM, Glerup M, Stoustrup P. Restricted upper airway dimensions in patients with dentofacial deformity from juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:32. [PMID: 35477405 PMCID: PMC9044879 DOI: 10.1186/s12969-022-00691-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This retrospective, cross-sectional study aimed to assess the pharyngeal airway dimensions of patients with juvenile idiopathic arthritis (JIA) and moderate/severe JIA-related dentofacial deformity (mandibular retrognathia/micrognathia), and compare the results with JIA patients with a normal mandibular appearance and a group of non-JIA patients. METHODS Seventy-eight patients were retrospectively included in a 1:1:1 manner as specified below. All patients had previously been treated at the Section of Orthodontics, Aarhus University, Denmark. All had a pretreatment cone beam computed tomography (CBCT). Group 1 (JIA+); 26 JIA patients with severe arthritis-related dentofacial deformity and mandibular retrognathia/micrognathia. Group 2 (JIA-); 26 JIA patients with normal mandibular morphology/position. Group 3 (Controls); 26 non-JIA subjects. Dentofacial morphology and upper airway dimensions, excluding the nasal cavity, were assessed in a validated three-dimensional (3D) fashion. Assessment of dentofacial deformity comprised six morphometric measures. Assessment of airway dimensions comprised nine measures. RESULTS Five morphometric measures of dentofacial deformity were significantly deviating in the JIA+ group compared with the JIA- and control groups: Posterior mandibular height, anterior facial height, mandibular inclination, mandibular occlusal inclination, and mandibular sagittal position. Five of the airway measurements showed significant inter-group differences: JIA+ had a significantly smaller nasopharyngeal airway dimension (ad2-PNS), a smaller velopharyngeal volume, a smaller minimal cross-sectional area and a smaller minimal hydraulic diameter than JIA- and controls. No significant differences in upper airway dimensions were seen between JIA- and controls. CONCLUSION JIA patients with severe arthritis-related dentofacial deformity and mandibular micrognathia had significantly restricted upper airway dimensions compared with JIA patients without dentofacial deformity and controls. The restrictions of upper airway dimension seen in the JIA+ group herein were previously associated with sleep-disordered breathing in the non-JIA background population. Further studies are needed to elucidate the role of dentofacial deformity and restricted airways in the development of sleep-disordered breathing in JIA.
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Affiliation(s)
- Xiaowen Niu
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Julianne Moland
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark
| | - Thomas Klit Pedersen
- grid.7048.b0000 0001 1956 2722Section of Orthodontics, Aarhus University, Aarhus, Denmark ,grid.154185.c0000 0004 0512 597XDepartment of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Ellern Bilgrau
- grid.5117.20000 0001 0742 471XDepartment of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Paolo M. Cattaneo
- grid.7048.b0000 0001 1956 2722Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia, Formerly, Section of Orthodontics, Aarhus University, Denmark, Aarhus, Denmark
| | - Mia Glerup
- grid.154185.c0000 0004 0512 597XDepartment of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark.
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17
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A clinical and MRI retrospective cohort study of patients with juvenile idiopathic arthritis (JIA) to determine if initial temporomandibular joint (TMJ) examination findings are associated with severity of TMJ arthritis. J Craniomaxillofac Surg 2022; 50:328-335. [DOI: 10.1016/j.jcms.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
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Abstract
Patients with juvenile idiopathic arthritis (JIA) often have involvement of the temporomandibular joint (TMJ) during their disease course. Active arthritis of the TMJ remains difficult to assess. Clinical signs and symptoms alone are unreliable, and active TMJ arthritis needs confirmation by gadolinium-enhanced MRI. In recent years, changes in treatment approach have occurred. This article discusses the latest evidence on diagnosis and treatment of JIA-associated TMJ arthritis.
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19
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Fischer J, Augdal TA, Angenete O, Gil EG, Skeie MS, Åstrøm AN, Tylleskär K, Rosendahl K, Shi XQ, Rosén A. In children and adolescents with temporomandibular disorder assembled with juvenile idiopathic arthritis - no association were found between pain and TMJ deformities using CBCT. BMC Oral Health 2021; 21:518. [PMID: 34641860 PMCID: PMC8513178 DOI: 10.1186/s12903-021-01870-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. Methods This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. Results Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). Conclusions There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01870-z.
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Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.
| | - T A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - O Angenete
- Department of Radiology and Nuclear Medicine, St. Olav Hospital HF, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - E G Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway
| | - A N Åstrøm
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Public Dental Service Competence Centre of Western-Norway (TkVest), Bergen, Norway
| | - K Tylleskär
- Paediatric Clinic at Haukeland University Hospital, Bergen, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT Arctic University of North Norway, Tromsø, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - A Rosén
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, 5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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20
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Initial radiological signs of dentofacial deformity in juvenile idiopathic arthritis. Sci Rep 2021; 11:13142. [PMID: 34162967 PMCID: PMC8222246 DOI: 10.1038/s41598-021-92575-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/08/2021] [Indexed: 01/12/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood and the temporomandibular joint (TMJ) is often involved. TMJ arthritis in growing individuals can cause deformation of facial skeleton (dentofacial deformity) and TMJ components (TMJ deformity). Treatment outcome hinges on early initiation of anti-inflammatory treatment and orthopaedic treatment with dental splints. The aim of the present study was to characterize the radiological signs of dentofacial deformity in patients with a JIA-induced need for orthopaedic treatment. We retrospectively studied 96 patients with JIA and 20 non-JIA controls to identify the initial radiological signs of JIA-induced dentofacial deformity leading to initiation of orthopaedic treatment. We found that initial radiological signs of dentofacial deformities were subtle and characterized by minor mandibular asymmetry and occlusal plane steepening. Radiological findings of TMJ deformity associated with initial dentofacial deformity were frequent and characterized by condylar articular surface flattening (OR 8.42), condylar subcortical cyst (OR 5.94), condylar surface erosion (OR 5.38) and condylar deviation in form (OR 25.39). Radiological signs of TMJ deformity were also documented in TMJs considered “healthy” during initial clinical and radiological examination. This study presents new knowledge of importance for early diagnosis of dentofacial deformity in JIA. Early diagnosis of dentofacial deformity is important as treatment outcome is greatly influenced by timely initiation.
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Bridges JM, Mellins ED, Cron RQ. Recent progress in the treatment of non-systemic juvenile idiopathic arthritis. Fac Rev 2021; 10:23. [PMID: 33718940 PMCID: PMC7946384 DOI: 10.12703/r/10-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease affecting the joints and other organs that occurs in 1 in 1,000 children in the United States. Given the various categories of JIA, interpretation of the literature can be difficult. In this review, new developments in understanding non-systemic JIA and its treatment will be covered. Recent advances in the journey toward personalized treatment in JIA will be highlighted, including a review of currently available biologic modifiers. Uveitis and the temporomandibular joint will be discussed as particularly challenging treatment issues. Recent guideline updates and literature-guided treatment decisions will be reviewed.
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Affiliation(s)
- John M Bridges
- Children’s of Alabama/University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, California, USA
| | - Randy Q Cron
- Children’s of Alabama/University of Alabama at Birmingham, Birmingham, Alabama, USA
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Comparing Clinical and Radiological Manifestations of Adolescent Idiopathic Condylar Resorption and Juvenile Idiopathic Arthritis in the Temporomandibular Joint. J Oral Maxillofac Surg 2020; 79:774-785. [PMID: 33217307 DOI: 10.1016/j.joms.2020.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE This cross-sectional study compared orofacial manifestations at the time of diagnosis in 2 temporomandibular joint (TMJ) conditions: adolescent idiopathic condylar resorption (ICR) and TMJ involvement from juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS This retrospective study included 19 JIAs, 19 ICRs, and 19 control patients, all treated at the Section of Orthodontics, Aarhus University Craniofacial Clinic, Denmark. From patient files, we retrieved radiological data from cone-beam computed tomographies along with information on symptoms and orofacial function at the time of diagnosis. Validated methodologies were used to evaluate TMJ and dentofacial morphology. RESULTS We found no statistically significant intergroup differences in severity of deformation of TMJ structures (TMJ deformity) between JIA and ICR patients. However, the ICR group showed significantly greater signs of dentofacial deformity on 4 outcome variables: mandibular inclination, posterior/anterior lower face height ratio, mandibular sagittal position, and mandibular occlusal plane inclination. Significant intergroup differences in clinical presentation were seen in 5 of 20 variables. Thus, the JIA group reported significantly more symptoms of TMJ pain, TMJ morning stiffness, and TMJ pain on palpation during the clinical examination, whereas the ICR group reported significantly more TMJ clicking during function and had a higher proportion of patients with anterior open bite. CONCLUSIONS Cone-beam computed tomography examination showed a similar degree of TMJ deformity in ICR and JIA patients at the time of diagnosis. ICR patients presented with a significantly higher degree of dentofacial deformity than JIA patients and healthy controls, which relates to the timing of the diagnosis. Arthralgia, TMJ morning stiffness, and TMJ palpitation pain were more common in JIA patients, whereas TMJ clicking during function and anterior open bites were more common in ICR patients.
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Stoustrup P, Twilt M, Herlin T. Systemic Treatment for Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis. J Rheumatol 2020; 47:793-795. [PMID: 32482885 DOI: 10.3899/jrheum.191169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Aarhus, Denmark;
| | - Marinka Twilt
- Cumming School of Medicine, Alberta Children's Research Institute, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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24
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Fischer J, Skeie MS, Rosendahl K, Tylleskär K, Lie S, Shi XQ, Gil EG, Cetrelli L, Halbig J, von Wangenheim Marti L, Rygg M, Frid P, Stoustrup P, Rosèn A. Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis - a Norwegian cross- sectional multicentre study. BMC Oral Health 2020; 20:282. [PMID: 33050890 PMCID: PMC7557069 DOI: 10.1186/s12903-020-01234-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/25/2020] [Indexed: 12/30/2022] Open
Abstract
Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. Methods This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. Results In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p < 0.001). Vertical unassisted jaw movement was lower in participants with JIA than in controls, with means of 46.2 mm vs. 49.0 mm, respectively (p < 0.001). Among participants with JIA, a higher proportion of those using synthetic disease-modifying antirheumatic-drugs and biologic disease-modifying antirheumatic-drugs presented with painful masticatory muscles and TMJs at palpation. Conclusion Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.
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Affiliation(s)
- J Fischer
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.
| | - M S Skeie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Center for Oral Health Services and Research of Middle-Norway (TkMidt), Trondheim, Norway
| | - K Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway.,UiT the Arctic University of North Norway, Tromsø, Norway
| | - K Tylleskär
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - S Lie
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - X-Q Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - E Grut Gil
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - L Cetrelli
- Center for Oral Health Services and Research of Middle-Norway (TkMidt), Trondheim, Norway
| | - J Halbig
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway
| | - L von Wangenheim Marti
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway
| | - M Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - P Frid
- Public Dental Service Competence Centre of Northern-Norway (TkNN), Tromsø, Norway.,Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - P Stoustrup
- Section of Orthodontics, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - A Rosèn
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Årstadveien 19, N-5009, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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Dimitrijevic Carlsson A, Wahlund K, Kindgren E, Skogh T, Starkhammar Johansson C, Alstergren P. Orofacial pain in juvenile idiopathic arthritis is associated with stress as well as psychosocial and functional limitations. Pediatr Rheumatol Online J 2019; 17:83. [PMID: 31856854 PMCID: PMC6921529 DOI: 10.1186/s12969-019-0385-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate relations between psychosocial factors, signs and symptoms of orofacial pain and jaw dysfunction in patients with juvenile idiopathic arthritis (JIA). METHODS Forty-five patients with JIA (median age 12 years) and 16 healthy matched controls (median age 13 years) were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered the DC/TMD questionnaires regarding psychosocial factors (pain intensity, pain-related disability, depression, stress, catastrophizing, pain locations and jaw function). RESULTS JIA patients with orofacial pain had higher degree of stress, depression, catastrophizing and jaw dysfunction compared to subjects without. In turn, these factors were associated with orofacial pain intensity. Also, patients with orofacial pain had higher systemic inflammatory activity. CONCLUSIONS Orofacial pain in patients with JIA is associated with stress, psychological distress, jaw dysfunction and loss of daily living activities. Pain intensity seems to be the major pain aspect related to these factors. In addition, systemic inflammatory activity appears to be an important factor contributing to orofacial pain in JIA.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden. .,Center for Oral Rehabilitation in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. .,Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden.
| | - Kerstin Wahlund
- 0000 0004 0636 5406grid.413799.1Department of Stomatognathic Physiology, Kalmar County Hospital, Kalmar, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden ,0000 0001 2162 9922grid.5640.7Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden ,grid.416029.8Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Thomas Skogh
- 0000 0001 2162 9922grid.5640.7Division of Neuro and Inflammation Sciences, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Carin Starkhammar Johansson
- 0000 0001 2162 9922grid.5640.7Center for Oral Rehabilitation in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- 0000 0000 9961 9487grid.32995.34Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden ,Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden ,0000 0004 0623 9987grid.411843.bSkåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden ,0000 0000 9961 9487grid.32995.34Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Stoustrup P, Herlin T, Spiegel L, Rahimi H, Koos B, Pedersen TK, Twilt M. Standardizing the Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: An Interdisciplinary, Consensus-based, Short Screening Protocol. J Rheumatol 2019; 47:1397-1404. [PMID: 31787607 DOI: 10.3899/jrheum.190661] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop a consensus-based, standardized, short (< 3 min) clinical examination protocol to assess the multidimensional, orofacial manifestations of juvenile idiopathic arthritis (JIA). METHODS The study was conducted by a multidisciplinary task force from the Temporomandibular Joint Juvenile Arthritis Working Group (TMJaw). The study used an acknowledged sequential approach involving (1) a global multidisciplinary online questionnaire study, (2) a systematic literature review and consensus meetings to identify items for inclusion, (3) pilot testing of included items, (4) test of reliability in 22 subjects with JIA by 4 examiners, (5) test of construct validity in a case-control study involving 167 subjects, and (6) establishment of final recommendations. RESULTS Six items were recommended for the final examination protocol: (1) clinician-assessed pain location, (2) temporomandibular (TMJ) joint pain on palpation (open and closed mouth), (3) mandibular deviation at maximal mouth opening (≥ 3 mm), (4) maximal unassisted mouth opening capacity, (5) frontal facial symmetry, and (6) facial profile. All recommended items showed acceptable reliability and construct validity. The average mean examination time was 2 min and 42 s (SD ± 38.5 s). CONCLUSION A consensus-based, short clinical examination protocol was developed. The protocol takes less than 3 min to complete and provides information about orofacial symptoms, TMJ dysfunction, and dentofacial deformity. The standardized examination protocol is applicable to routine clinical care, as well as future research studies.
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Affiliation(s)
- Peter Stoustrup
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany. .,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital.
| | - Troels Herlin
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital
| | - Lynn Spiegel
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital
| | - Hanna Rahimi
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital
| | - Bernd Koos
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital
| | - Thomas Klit Pedersen
- From the Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus; Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario; Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada; Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.,P. Stoustrup, DDS, PhD, Associate Professor of Orthodontics, Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University; T. Herlin, Professor, MD, DMSci, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; L. Spiegel, MD, FRCPC, Department of Pediatrics, Division of Rheumatology, The Hospital for Sick Children, University of Toronto; H. Rahimi, MD, Pediatric Rheumatology Clinic, Pediatrics and Adolescent Medicine, Aarhus University Hospital; B. Koos, DDS, PhD, Professor, Department of Orthodontics, University Hospital Tübingen; T.K. Pedersen, PhD, Consultant Orthodontist, Professor, Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Section of Orthodontics, Aarhus University; M. Twilt, MD, MSCE, PhD, Assistant Professor, Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital
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Stoustrup P, Pedersen TK, Nørholt SE, Resnick CM, Abramowicz S. Interdisciplinary Management of Dentofacial Deformity in Juvenile Idiopathic Arthritis. Oral Maxillofac Surg Clin North Am 2019; 32:117-134. [PMID: 31699581 DOI: 10.1016/j.coms.2019.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Temporomandibular joint (TMJ) arthritis impacts mandibular growth and development. This can result in skeletal deformity, such as facial asymmetry and/or malocclusion asymmetry. This article reviews the unique properties of TMJ and dentofacial growth and development in the setting of juvenile idiopathic arthritis (JIA). Specific orthopedic/orthodontic and surgical management of children with JIA and TMJ arthritis is discussed. The importance of interdisciplinary collaboration is highlighted.
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Affiliation(s)
- Peter Stoustrup
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus C, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark; Section of Oral Maxillofacial Surgery, Aarhus University, Vennelyst Boulevard 9-11, 8000 Aarhus, Denmark
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 longwood Avenue, Boston, MA 02115, USA; Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA
| | - Shelly Abramowicz
- Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, 1365 Clifton Road, Building B, Suite 2300, Atlanta, GA 30322, USA.
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