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Wilk M, Zimba O, Haugeberg G, Korkosz M. Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications. Rheumatol Int 2024; 44:985-1002. [PMID: 38609656 PMCID: PMC11108955 DOI: 10.1007/s00296-024-05583-8] [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: 02/21/2024] [Accepted: 03/12/2024] [Indexed: 04/14/2024]
Abstract
Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
| | - Olena Zimba
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mariusz Korkosz
- Division of Rheumatology, Immunology and Internal Medicine, University Hospital in Krakow, Krakow, Poland.
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Świętej Anny 12 St., 31-008, Kraków, Poland.
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Ronsivalle V, Marrapodi MM, Tirupathi S, Afnan L, Cicciù M, Minervini G. Prevalence of temporomandibular disorders in juvenile idiopathic arthritis evaluated with diagnostic criteria for temporomandibular disorders: A systematic review with meta-analysis. J Oral Rehabil 2024; 51:628-637. [PMID: 38012098 DOI: 10.1111/joor.13625] [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: 09/25/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a very common systemic inflammatory rheumatic disorder affecting the musculoskeletal system in children below 16 years of age. Joint inflammation and tissue destruction is the prime characteristic of the disease. Along with the systemic involvement in the long joints, several studies are mentioning the increased association of temporomandibular disorders (TMDs) in JIA. This current systematic review intends to find the prevalence rate of TMD in JIA-affected individuals as compared to healthy controls. METHODS We have searched in PubMed, Scopus and Ovid SP for articles published between the timeframe 1 January 1990 and 1 June 2023. All the searched articles were subjected to the Population, Exposure, Comparison, and Outcome model (PECO) based on which inclusion or exclusion is carried out. Participants (P) are children below 18 years of age, Exposure (E) is children or adolescents with a diagnosis of JIA, Comparator is age and gender-matched healthy controls who has no JIA or any systemic disorder, Outcome (O) is the prevalence of TMD. Only the studies that evaluated TMD using diagnostic criteria for evaluation of TMD (DC/TMD) were included in the analysis. We have set the exclusion to the following reasons- diagnostic sensitivity studies, case reports, and systematic reviews. The software Review Manager Version 5.4 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (JIA and no JIA) for the outcome TMD. RESULTS The pooled total included subjects were 366 in this review with an established diagnosis of JIA as evaluated by DC/TMD. The overall effect of the pooled data suggests that there is a significant difference in the TMD prevalence in the JIA group when compared to the control, results suggest that TMD is more prevalent in the JIA group RR 3.86; 95% CI [2.59, 5.76]. CONCLUSION Overall, based on the data we can suggest a positive relationship between JIA and TMD, hence presence of JIA can be a risk factor for the development of TMD. The sensitivity of DC/TMD is low when compared to magnetic resonance imaging.
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Affiliation(s)
- Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sunnypriyatham Tirupathi
- Department of Pediatric and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Lamea Afnan
- Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Karnataka, India
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
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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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4
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Brandelli YN, Chambers CT, Mackinnon SP, Parker JA, Huber AM, Stinson JN, Wildeboer EM, Wilson JP, Piccolo O. A systematic review of the psychosocial factors associated with pain in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:57. [PMID: 37328738 DOI: 10.1186/s12969-023-00828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/22/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain remains challenging. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors of children with JIA and their caregivers 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0-17 years of age. METHODS The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus. RESULTS Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified predominantly significant associations between pain and primary and secondary appraisals (e.g., more child pain beliefs, lower parent/child self-efficacy, lower child social functioning), parent/child internalizing symptoms, and lower child well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Fewer beliefs of harm, disability, and no control were associated with lower pain at follow-up, whereas internalizing symptoms and lower well-being were predictive of higher pain at follow-up (bidirectional relationships were also identified). CONCLUSIONS Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management, informs the role of psychosocial supports, and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger samples and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA. TRIAL REGISTRATION PROSPERO CRD42021266716.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada.
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Sean P Mackinnon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Rheumatology, IWK Health, Halifax, NS, Canada
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Emily M Wildeboer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, BC, Canada
| | - Olivia Piccolo
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
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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: 9] [Impact Index Per Article: 9.0] [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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Sangalli L, Gibler R, Boggero I. Pediatric Chronic Orofacial Pain: A Narrative Review of Biopsychosocial Associations and Treatment Approaches. FRONTIERS IN PAIN RESEARCH 2022; 2:790420. [PMID: 35295480 PMCID: PMC8915750 DOI: 10.3389/fpain.2021.790420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/02/2021] [Indexed: 12/28/2022] Open
Abstract
Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting >3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.
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Affiliation(s)
- Linda Sangalli
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, KY, United States
| | - Robert Gibler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ian Boggero
- Department of Oral Health Science, Division of Orofacial Pain, University of Kentucky, College of Dentistry, Lexington, KY, United States
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Mental Health in Pediatric Rheumatology: An Opportunity to Improve Outcomes. Rheum Dis Clin North Am 2021; 48:67-90. [PMID: 34798960 DOI: 10.1016/j.rdc.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Mental health problems are more common in children with pediatric rheumatologic diseases (PRDs) than healthy peers. Mental health problems affect disease-related outcomes and health-related quality of life (HRQOL), so addressing these problems can improve clinical and psychosocial outcomes. Mental health screening tools are available, and there are resources available to aid in integrating mental health care into the clinical setting. By implementing these tools, mental health problems can be recognized and addressed.
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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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Sieberg CB, Lebel A, Silliman E, Holmes S, Borsook D, Elman I. Left to themselves: Time to target chronic pain in childhood rare diseases. Neurosci Biobehav Rev 2021; 126:276-288. [PMID: 33774086 PMCID: PMC8738995 DOI: 10.1016/j.neubiorev.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic pain is prevalent among patients with rare diseases (RDs). However, little is understood about how biopsychosocial mechanisms may be integrated in the unique set of clinical features and therapeutic challenges inherent in their pain conditions. METHODS This review presents examples of major categories of RDs with particular pain conditions. In addition, we provide translational evidence on clinical and scientific rationale for psychosocially- and neurodevelopmentally-informed treatment of pain in RD patients. RESULTS Neurobiological and functional overlap between various RD syndromes and pain states suggests amalgamation and mutual modulation of the respective conditions. Emotional sequelae could be construed as an emotional homologue of physical pain mediated via overlapping brain circuitry. Given their clearly defined genetic and molecular etiologies, RDs may serve as heuristic models for unraveling pathophysiological processes inherent in chronic pain. CONCLUSIONS Systematic evaluation of chronic pain in patients with RD contributes to sophisticated insight into both pain and their psychosocial correlates, which could transform treatment.
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Affiliation(s)
- Christine B Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Alyssa Lebel
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Erin Silliman
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Scott Holmes
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Igor Elman
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, 02139, USA
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10
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Juvenile idiopathic arthritis of the temporomandibular joint - no longer the forgotten joint. Br J Oral Maxillofac Surg 2021; 60:247-256. [PMID: 35249742 DOI: 10.1016/j.bjoms.2021.03.013] [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: 10/21/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
Juvenile idiopathic arthritis (JIA) of the temporomandibular joint (TMJ) is common in children, with an increasing awareness of the condition in all healthcare professionals. TMJ involvement presents a challenge in both diagnosis and treatment, as late presentation can still occur as the disease often develops asymptomatically. This can result in facial deformity and/or functional difficulties including obstructive sleep apnoea. Early diagnosis is therefore essential, requiring a high index of clinical suspicion coupled with the judicious use of gadolinium contrast magnetic resonance imaging (MRI). Long-term management is best provided by a multidisciplinary team as patients often need a combination of pharmacological management, surgical interventions, orthodontics, and psychological support. End stage deformity can be treated by different surgical options, each with their own risks and benefits, however recently there is increasing recognition for the role of total alloplastic TMJ replacement. This review focuses on the diagnosis and management of TMJ arthritis and aims to highlight the important role of maxillofacial surgeons in JIA treatment.
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11
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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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12
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Lypka M, Shah K, Jones J. Prosthetic temporomandibular joint reconstruction in a cohort of adolescent females with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2020; 18:68. [PMID: 32887620 PMCID: PMC7487714 DOI: 10.1186/s12969-020-00453-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Temporomandibular joint (TMJ) arthritis and involvement is commonly seen in Juvenile Idiopathic Arthritis (JIA). Therapy includes conservative measures, but also includes intraarticular corticosteroid injections (IASI) and systemic immunosuppressive therapy. Despite aggressive medical therapy, some patients develop arthritic changes and frank TMJ ankylosis that can result in persistent pain and limitation in range of motion (ROM). A surgical option is prosthetic TMJ replacement with concurrent correction of dentofacial deformities, which can be performed simultaneously. The objective of this study was to evaluate the outcomes of prosthetic TMJ replacement in a cohort of adolescent females with JIA and severe TMJ involvement. METHODS This is a retrospective case series that took place at one tertiary care center. Patients with a diagnosis of JIA who also underwent alloplastic TMJ replacement were identified through electronic medical record system (EMR) and reviewed. Chart review included analysis of all documents in the EMR, including demographic data, JIA history, surgical complications, ROM of TMJ measured by maximal incisal opening in millimeters (mm) and TMJ pain scores (4-point Likert scale: none, mild, moderate, severe) obtained pre- and postoperatively. RESULTS Five female patients, ages 15-17 year when TMJ replacement was performed, had nine total joints replaced with a post-operative follow-up period of 12-30 months. All patients had polyarticular, seronegative JIA and were treated with IASI and multiple immunosuppressive therapies without resolution of TMJ symptoms. One patient had bilateral TMJ ankylosis. Three of the five patients demonstrated significant dentofacial deformities, and all underwent simultaneous or staged orthognathic surgery. All patients had improvement in TMJ pain with most (80%) reporting no pain, and all had similar or improved ROM of their TMJ postoperatively. There was one delayed postoperative infection with Cutibacterium Acnes that presented 15 months after surgery and required removal and reimplantation of prosthesis. CONCLUSION The sequelae of TMJ arthritis and involvement from JIA in the adolescent population can be difficult to treat. Current medical therapy can be successful, however, in select cases that develop chronic changes in the TMJ despite extensive medical therapy, early results show that prosthetic joint replacement maybe a reasonable surgical option. With prosthetic joint replacement pain levels were reduced and range of motion was maintained or improved for all patients.
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Affiliation(s)
- Michael Lypka
- Division of Plastic and Craniofacial Surgery, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA. .,University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA.
| | - Karina Shah
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA
| | - Jordan Jones
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108 USA ,grid.239559.10000 0004 0415 5050Division of Rheumatology, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 USA
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