Maximal mouth opening is a simple method to evaluate the treatment outcome of temporomandibular joint arthritis in patients with juvenile idiopathic arthritis

Authors

  • Mia Huhtanen Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland; Oral Health Care, Espoo Health Care Centre, Western Uusimaa Wellbeing Services County, Espoo, Finland
  • Katriina Mikola New Children’s Hospital, Paediatric Research Centre University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  • Anu Kiukkonen Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
  • Tuula Palotie Orthodontics, Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland

DOI:

https://doi.org/10.2340/aos.v83.42438

Keywords:

Juvenile idiopathic arthritis, temporomandibular joint arthritis, magnetic resonance imaging, intra-articular corticosteroid injections

Abstract

Objective: Temporomandibular joint (TMJ) arthritis is a common finding in juvenile idiopathic arthritis (JIA) patients. TMJ arthritis can cause significant disturbances in TMJ function and growth without treatment. Our aim was to evaluate the effectiveness of medical treatments used to manage TMJ arthritis and how to evaluate the outcome of the treatment. Furthermore, this study aimed to ascertain the prevalence of TMJ arthritis in JIA patients and investigate the potential impact of specific factors.

Material and methods: Between 2015 and 2019, a total of 194 JIA patients who received treatment at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Finland were included in the study. We retrospectively screened the patient records and imaging studies to find out how many patients had TMJ arthritis and what medication was used to treat it.

Results: Maximal incisal mouth opening (MIO) increased significantly with patients whose TMJ arthritis was successfully treated with intra-articular corticosteroid injection (IACI). Almost all patients with TMJ arthritis were treated with an IACI at some point during their treatment. Overall, 99 patients (51%) had been diagnosed with TMJ arthritis. No statistical difference was found between the prevalence of TMJ arthritis and different JIA subtypes, JIA onset time, gender, or immunological factors.

Conclusion: MIO is an easy way to evaluate the treatment outcome and possible disease activation of TMJ arthritis. The prevalence of TMJ arthritis is high among JIA patients. In our study, we could not find any parameters that predict TMJ arthritis, and despite systemic medication, TMJ arthritis might occur.

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References

Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369(9563):​767–78. https://doi.org/10.1016/S0140-6736(07)60363-8 DOI: https://doi.org/10.1016/S0140-6736(07)60363-8

Crayne CB, Beukelman T. Juvenile idiopathic arthritis: oligoarthritis and polyarthritis. Pediatr Clin North Am. 2018;65(4):657–74. https://doi.org/10.1016/j.pcl.2018.03.005 DOI: https://doi.org/10.1016/j.pcl.2018.03.005

Berntson L, Andersson Gäre B, Fasth A, Herlin T, Kristinsson J, Lahdenne P, et al. Incidence of juvenile idiopathic arthritis in the nordic countries. A population based study with special reference to the validity of the ILAR and EULAR criteria. J Rheumatol. 2003;30(10):2275–82.

Cattalini M, Soliani M, Caparello MC, Cimaz R. Sex differences in pediatric rheumatology. Clin Rev Allergy Immunol. 2019;56(3):293–307. https://doi.org/10.1007/s12016-017-8642-3 DOI: https://doi.org/10.1007/s12016-017-8642-3

Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, et al. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31(2):390–2.

Billiau AD, Hu Y, Verdonck A, Carels C, Wouters C. Temporomandibular joint arthritis in juvenile idiopathic arthritis: prevalence, clinical and radiological signs, and relation to dentofacial morphology. J Rheumatol. 2007;34(9):1925–33.

Weiss PF, Arabshahi B, Johnson A, Bilaniuk LT, Zarnow D, Cahill AM, et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arthritis Rheum. 2008;58(4):1189–96. https://doi.org/10.1002/art.23401 DOI: https://doi.org/10.1002/art.23401

Twilt M, Schulten AJM, Verschure F, Wisse L, Prahl-Andersen B, van Suijlekom-Smit LWA. Long-term followup of temporomandibular joint involvement in juvenile idiopathic arthritis. Arthritis Rheum. 2008;59(4):546–52. https://doi.org/10.1002/art.23532 DOI: https://doi.org/10.1002/art.23532

Twilt M, Arends LR, Ten Cate R, Van Suijlekom-Smit LWA. Incidence of temporomandibular involvement in juvenile idiopathic arthritis. Scand J Rheumatol. 2004;31(7):1418–22.

Rönning O, Valiaho M-L, Laaksonen A-L. The involvement of the temporomandibular joint in juvenile rheumatoid arthritis. Scand J Rheumatol. 1974;3:89–96. https://doi.org/10.3109/03009747409115807 DOI: https://doi.org/10.3109/03009747409115807

Cannizzaro E, Schroeder S, Müller LM, Kellenberger CJ, Saurenmann RK. Temporomandibular joint involvement in children with juvenile idiopathic arthritis. J Rheumatol. 2011;38(3):510–15. https://doi.org/10.3899/jrheum.100325 DOI: https://doi.org/10.3899/jrheum.100325

Stoll ML, Sharpe T, Beukelman T, Good J, Young D, Cron RQ. Risk factors for temporomandibular joint arthritis in children with juvenile idiopathic arthritis. J Rheumatol. 2012;39(9):1880–7. https://doi.org/10.3899/jrheum.111441 DOI: https://doi.org/10.3899/jrheum.111441

von Schuckmann L, Klotsche J, Suling A, Kahl-Nieke B, Foeldvari I. Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review. Scand J Rheumatol. 2020;49(4):271–80. https://doi.org/10.1080/03009742.2020.1720282 DOI: https://doi.org/10.1080/03009742.2020.1720282

Kjellberg H, Fasth A, Kiliaridis S, Wenneberg B, Thilander B. Craniofacial structure in children with juvenile chronic arthritis (JCA) compared with healthy children with ideal or postnormal occlusion. Am J Orthod Dentofac Orthop. 1995;107(1):67–78. https://doi.org/10.1016/S0889-5406(95)70158-3 DOI: https://doi.org/10.1016/S0889-5406(95)70158-3

Peltomäki T, Kreiborg S, Pedersen TK, Ogaard B. Craniofacial growth and dento-alveolar development in juvenile idiopathic arthritis patients. Semin Orthod. 2015;21(2):84–93. https://doi.org/10.1053/j.sodo.2015.02.004 DOI: https://doi.org/10.1053/j.sodo.2015.02.004

Karhulahti T, Rönning O, Jämsä T. Mandibular condyle lesions, jaw movements, and occlusal status in 15‐year‐old children with juvenile rheumatoid arthritis. Eur J Oral Sci. 1990;98(1):17–26. https://doi.org/10.1111/j.1600-0722.1990.tb00935.x DOI: https://doi.org/10.1111/j.1600-0722.1990.tb00935.x

Von Bremen J, Ruf S. Juvenile idiopathische arthritis – und nun? Eine systematische Literaturübersicht über Veränderungen der kraniofazialen Morphologie. J Orofac Orthop. 2012;73(4):265–76. https://doi.org/10.1007/s00056-012-0091-2 DOI: https://doi.org/10.1007/s00056-012-0091-2

Pedersen TK, Jensen JJ, Melsen B, Herlin T. Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. J Rheumatol. 2001;28(9):2109–15.

Arabshahi B, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis: the forgotten joint. Curr Opin Rheumatol. 2006;18(5):490–5. https://doi.org/10.1097/01.bor.0000240360.24465.4c DOI: https://doi.org/10.1097/01.bor.0000240360.24465.4c

Ravelli A, Consolaro A, Horneff G, Laxer RM, Lovell DJ, Wulffraat NM, et al. Treating juvenile idiopathic arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2018;77(6):​819–28. https://doi.org/10.1136/annrheumdis-2018-213030 DOI: https://doi.org/10.1136/annrheumdis-2018-213030

Tynjala P. Impact of anti-TNF treatment on growth in severe juvenile idiopathic arthritis. Ann Rheum Dis. 2006;65(8):1044–9. https://doi.org/10.1136/ard.2005.047225 DOI: https://doi.org/10.1136/ard.2005.047225

Giancane G, Muratore V, Marzetti V, Quilis N, Benavente BS, Bagnasco F, et al. Disease activity and damage in juvenile idiopathic arthritis: methotrexate era versus biologic era. Arthritis Res Ther. 2019;21(1):​1–10. https://doi.org/10.1186/s13075-019-1950-7 DOI: https://doi.org/10.1186/s13075-019-1950-7

Stoustrup P, Twilt M. Therapy: intra-articular steroids for TMJ ­arthritis – caution needed. Nat Rev Rheumatol. 2015;11(10):566–7. https://doi.org/10.1038/nrrheum.2015.97 DOI: https://doi.org/10.1038/nrrheum.2015.97

Lochbühler N, Saurenmann RK, Müller L, Kellenberger CJ. Magnetic resonance imaging assessment of temporomandibular joint involvement and mandibular growth following corticosteroid injection in juvenile idiopathic arthritis. J Rheumatol. 2015;42(8):1514–22. https://doi.org/10.3899/jrheum.141502 DOI: https://doi.org/10.3899/jrheum.141502

Stoll ML, Amin D, Powell KK, Poholek CH, Strait RH, Aban I, et al. Risk factors for intraarticular heterotopic bone formation in the temporomandibular joint in Juvenile idiopathic arthritis. J Rheumatol. 2018;45(9):1301–7. https://doi.org/10.3899/jrheum.171306 DOI: https://doi.org/10.3899/jrheum.171306

Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, et al. 2021 American College of Rheumatology guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for oligoarthritis, temporomandibular joint arthritis, and systemic juvenile idiopathic arthritis. Arthritis Rheumatol. 2022;74(4):553–69. https://doi.org/10.1002/art.42037 DOI: https://doi.org/10.1002/art.42037

Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res. 2019;71(6):717–34. https://doi.org/10.1002/acr.23870 DOI: https://doi.org/10.1002/acr.23870

Huhtanen M, Mikola K, Kiukkonen A, Palotie T. Craniofacial structures, occlusal features, and TMD symptoms in juvenile idiopathic arthritis patients: a retrospective study. Eur J Orthod. 2023;45(1):​88–95. https://doi.org/10.1093/ejo/cjac037 DOI: https://doi.org/10.1093/ejo/cjac037

Murray KJ, Moroldo MB, Donnelly P, Prahalad S, Passo MH, Giannini EH, et al. Age-specific effects of juvenile rheumatoid arthritis-­associated HLA alleles. Arthritis Rheum. 1999;42(9):1843–53. https://doi.org/10.1002/1529-0131(199909)42:9%3C1843::AID-ANR8%3E3.0.CO;2-M DOI: https://doi.org/10.1002/1529-0131(199909)42:9<1843::AID-ANR8>3.0.CO;2-M

Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, et al. Management of orofacial manifestations of juvenile idiopathic arthritis: interdisciplinary consensus-based recommendations. Arthritis Rheumatol. 2023;75(1):4–14. https://doi.org/10.1002/art.42338 DOI: https://doi.org/10.1002/art.42338

Stoustrup P, Resnick CM, Pedersen TK, Abramowicz S, Michelotti A, Küseler A, et al. Standardizing terminology and assessment for orofacial conditions in juvenile idiopathic arthritis: international, multidisciplinary consensus-based recommendations. J Rheumatol. 2019;46(5):518–22. https://doi.org/10.3899/jrheum.180785 DOI: https://doi.org/10.3899/jrheum.180785

Müller L, Kellenberger CJ, Cannizzaro E, Ettlin D, Schraner T, Bolt IB, et al. Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology. 2009;48(6):680–5. https://doi.org/10.1093/rheumatology/kep068 DOI: https://doi.org/10.1093/rheumatology/kep068

Stoustrup P, Twilt M, Spiegel L, Kristensen KD, Koos B, Pedersen TK, et al. Clinical orofacial examination in juvenile idiopathic arthritis: international consensus-based recommendations for monitoring patients in clinical practice and research studies. J Rheumatol. 2017;44(3):326–33. https://doi.org/10.3899/jrheum.160796 DOI: https://doi.org/10.3899/jrheum.160796

Antonarakis GS, Blanc A, Courvoisier DS, Scolozzi P. Effect of intra-­articular corticosteroid injections on pain and mouth opening in juvenile idiopathic arthritis with temporomandibular involvement: a systematic review and meta-analysis. J Cranio-Maxillofacial Surg. 2020;48(8):772–8. https://doi.org/10.1016/j.jcms.2020.06.010 DOI: https://doi.org/10.1016/j.jcms.2020.06.010

Ying QV, Bacic J, Abramowicz S, Sonis A. Normal maximal incisal opening and associations with physical variables in children. Pediatr Dent. 2013;35(1):61–6.

Stoustrup P, Verna C, Kristensen KD, Küseler A, Herlin T, Pedersen TK. Smallest detectable differences in clinical functional temporomandibular joint examination variables in juvenile idiopathic arthritis. Orthod Craniofacial Res. 2013;16(3):137–45. https://doi.org/10.1111/ocr.12008 DOI: https://doi.org/10.1111/ocr.12008

Kuseler A, Pedersen TK, Gelineck J, Herlin T. A 2 year followup study of enhanced magnetic resonance imaging and clinical examination of the temporomandibular joint in children with juvenile idiopathic arthritis. J Rheumatol. 2005;32(1):162–9.

Keller H, Müller LM, Markic G, Schraner T, Kellenberger CJ, Saurenmann RK. Is early TMJ involvement in children with juvenile idiopathic arthritis clinically detectable? Clinical examination of the TMJ in comparison with contrast enhanced MRI in patients with juvenile idiopathic arthritis. Pediatr Rheumatol. 2015;13(1):1–10. https://doi.org/10.1186/s12969-015-0056-2 DOI: https://doi.org/10.1186/s12969-015-0056-2

Kuseler A, Pedersen T, Herlin T, Gelineck J. Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis. J Rheumatol. 1998;25(7):1406–12.

Ince DO, Ince A, Moore TL. The effect pf methotrexate on the temporomandibular joint in polyarticular juvenile rheumatoid arthritis patients. J Clin Rheumatol. 1999;5(6):320–5. https://doi.org/10.1097/00124743-199912000-00004 DOI: https://doi.org/10.1097/00124743-199912000-00004

Bollhalder A, Patcas R, Eichenberger M, Müller L, Schroeder-Kohler S, Saurenmann RK, et al. Magnetic resonance imaging followup of temporomandibular joint inflammation, deformation, and mandibular growth in juvenile idiopathic arthritis patients receiving systemic treatment. J Rheumatol. 2020;47(6):909–16. https://doi.org/10.3899/jrheum.190168 DOI: https://doi.org/10.3899/jrheum.190168

Frid P, Augdal TA, Larheim TA, Halbig J, Rypdal V, Songstad NT, et al. Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study. Pediatr Rheumatol Online J. 2020;18(1):75. https://doi.org/10.1186/s12969-020-00464-3 DOI: https://doi.org/10.1186/s12969-020-00464-3

Published

2024-12-18