Oral and maxillofacial radiology
Radiographic TMJ abnormalities in patients with juvenile idiopathic arthritis followed for 27 years

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Objective

The objective of this study was to assess temporomandibular joint (TMJ) abnormalities in juvenile idiopathic arthritis (JIA) by longitudinal radiographic examinations from childhood to adulthood.

Study design

Radiographic TMJ evaluations of 60 JIA patients were obtained at baseline (mean age 8.6 years, mean disease duration 3.2 years) and 1 to 3 times thereafter, with the final examination on average 27 years after baseline. A radiographic grading system for severity of TMJ abnormality was applied.

Results

Cumulative radiographic TMJ abnormalities increased from baseline to final examination (42% to 75%, P < .001), as did bilateral TMJ involvement (60% to 82%, P < .001). Of patients with TMJ abnormalities, 53% showed progression, and 16% revealed signs of improvement. TMJ abnormalities were associated with physical limitations at baseline and reduced well-being and more extensive joint involvement at the final examination.

Conclusion

The frequency of TMJ abnormalities in JIA was high and increased from childhood to adulthood. Although progression of TMJ abnormalities was the general rule, near normalization also occurred on occasion.

Section snippets

Materials and Methods

The study was approved by the Regional Committee for Medical Research Ethics, Southern Norway, and informed consent was given for all subjects.

A group of 103 children with JIA was examined between 1976 and 1979,7 and reexamined 2 and 4 years after baseline. At each examination, similar radiographic methods for the TMJs were used; namely, panoramic and lateral transcranial radiography in closed and open mouth positions, occasionally supplemented by conventional lateral tomography.14

Between 2002

Results

In the analysis of the 64 healthy individuals, the condyles stayed rounded during growth and, although they did change somewhat in shape and size, they did not flatten. Occasionally, a slightly flattened condyle persisted as such (Fig. 2).

In the 60 JIA subjects, 25 (42%) had bone abnormalities in 1 or both TMJs at baseline (Fig. 3). The frequency of cumulative TMJ abnormalities increased to 34 subjects (57%) at first reexamination, to 37 (67%) at second examination, and to 45 (75%) at the final

Discussion

The present study is unusual in following JIA patients from childhood into adulthood with comprehensive, radiographic TMJ evaluations, using healthy individuals as controls.

The facial growth archives at the University of Oslo offer a unique opportunity to demonstrate that the mandibular condyle on the panoramic image has a rounded articular surface during growth in healthy individuals. The authors found a variety of shapes, but the condyle never changed from rounded to flattened. However, a few

Conclusions

Most JIA subjects in this long-term study developed radiographic TMJ abnormalities, predominantly involving both TMJs. In the vast majority, these joints were involved before the 15th birthday, and in more than half before the pubertal growth spurt. A more severe disease course led to more frequent and more severe TMJ involvement. Progression of the radiographic TMJ abnormalities was the most frequent course, but a small group clearly showed improvement toward normalization. The high frequency

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