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Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis: Prevalence, Clinical and Radiological Signs, and Relation to Dentofacial Morphology AN D. BILLIAU, YUQIAN HU, AN VERDONCK, CARINE CARELS, and CARINE WOUTERS
ABSTRACT. Methods. Clinical rheumatologic and orthodontic evaluations were performed in 100 patients with JIA [12 systemic arthritis, 24 rheumatoid factor (RF)-negative polyarthritis, 1 RF-positive polyarthritis, 39 oligoarthritis, 22 enthesitis-related arthritis, 2 psoriatic arthritis]. An orthopantomogram and lateral cephalogram were performed in 46 patients. The prevalence of TMJ arthritis was studied in relation to JIA subtype and disease characteristics; cephalometric measurements were compared to those from age- and sex-matched healthy controls. Results. Whereas 55% of patients with JIA had at least one symptom/sign of TMJ arthritis, 78% of the radiographed group exhibited condylar lesions. The presence of condylar damage was not related to clinical orthodontic findings or to JIA subtype, disease activity, severity, or duration. Patients with JIA exhibited larger mandibular plane and A-nasion-B angles, larger total anterior facial height, smaller interincisal and sella-nasion-B angles, and shorter mandibular ramus lengths than their age- and sex-matched controls. Craniofacial alterations were clearly related to the presence of condylar damage, even when present at a minimal degree. Conclusion. Our data show that TMJ condylar damage occurs very frequently in JIA, and irrespective of JIA subtype; condylar lesions can present early, progress insidiously, and — even at a minimal degree — can severely alter the craniofacial profile. We propose that the followup of patients with JIA should include early and regular evaluation by an orthodontist, supplemented with radiographic TMJ imaging. (First Release August 1 2007; J Rheumatol 2007;34:1925-33) Key Indexing Terms:
TEMPOROMANDIBULAR JOINT
From the Department of Pediatric Rheumatology and Department of Orthodontics, University Hospital Leuven; and Laboratory of Experimental Transplantation, University of Leuven, Leuven, Belgium. A.D. Billiau is a postdoctoral fellow of the FWO Vlaanderen. Dr. Billiau and Dr. Hu contributed equally to this report. A.D. Billiau, MD, PhD, Pediatric Rheumatologist, Department of Pediatric Rheumatology, University Hospital Leuven, Postdoctoral Research Fellow, Laboratory of Experimental Transplantation; Y. Hu, DDS, Fellow; A. Verdonck, DDS, PhD, Staff Member; C. Carels, DDS, PhD, Professor, Head, Department of Orthodontics; C. Wouters, MD, PhD, Professor, Head, Department of Pediatric Rheumatology, University Hospital Leuven. Address reprint requests to Dr. C. Wouters, Department of Pediatric Rheumatology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. E-mail: carine.wouters@uz.kuleuven.ac.be Accepted for publication April 16, 2007. |
