Temporomandibular Involvement in Juvenile Idiopathic Arthritis

MARINKA TWILT, SHELL M.L.M. MOBERS, LIDIA R. ARENDS, REBECCA ten CATE, and LISETTE W.A. van SUIJLEKOM-SMIT

ABSTRACT.

Objective. To study occurrence as well as clinical signs and symptoms of temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) in a population representing all subtypes of JIA.

Methods. Ninety-seven consecutive children with JIA underwent orthodontic evaluation including an orthopantomogram (OPG). Further evaluation included patient characteristics, disease onset, course, and medical treatment.

Results. Forty-five percent of all children had TMJ involvement. Frequencies according to JIA subtypes: systemic 67%, oligoarticular (persistent and extended) 39%, rheumatoid factor (RF) negative polyarticular 59%, RF positive polyarticular 33%, enthesitis related arthritis 13%, psoriatic arthritis 33%, and other arthritis 50%. In children with a polyarticular course, irrespective of their disease onset, TMJ involvement was more frequent (55% vs 31% in oligoarticular course). In children with disease onset at a young age and/or an extended course of the disease, TMJ involvement was also more frequent. Pain during jaw excursion, absence of translation, asymmetry during maximal opening and protrusion, as well as crepitation during evaluation are predictors for TMJ involvement with a good specificity but a low sensitivity. Not all patients with TMJ involvement have clinical signs.

Conclusion. Because of the high prevalence and discrepancy between clinical signs and presence of arthritis of the TMJ, regular orthodontic evaluation and OPG is recommended to recognize TMJ involvement and enable early intervention. (J Rheumatol 2004;31:1418-22)

Key Indexing Terms:

JUVENILE IDIOPATHIC ARTHRITIS
TEMPOROMANDIBULAR JOINT

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From the Departments of Pediatrics, Orthodontics, and Epidemiology and Biostatistics, Erasmus MC Sophia Children's Hospital, Rotterdam; and the Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.

M. Twilt, MD; L.W.A. van Suijlekom-Smit, Pediatric Rheumatologist, MD, PhD, Department of Pediatrics; S.M.L.M. Mobers, Orthodontist, Department of Orthodontics; L.R. Arends, MSc, MA, Department of Epidemiology and Biostatistics, Erasmus MC Sophia Children's Hospital; R. ten Cate, MD, PhD, Pediatric Rheumatologist, Department of Pediatrics, Erasmus MC Sophia Children's Hospital and Department of Pediatrics, Leiden University Medical Centre.

Address reprint requests to Dr. M. Twilt, Department of Pediatrics, Sp 1545, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: m.twilt@erasmusmc.nl

Submitted July 4, 2003; revision accepted January 27, 2004.

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