Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral MedicineOrofacial pain, jaw function, and temporomandibular disorders in women with a history of juvenile chronic arthritis or persistent juvenile chronic arthritis*,**
Section snippets
Patients
In 1979 and 1980, Kreiborg et al4 and Pedersen et al18 performed a referral-based follow-up study of 93 patients with JCA admitted to the Hornbaek Hospital of Physical Medicine, Denmark, during the period from 1965 through 1977. From this group, 65 patients were followed up in 1996 and 1997.19 To secure homogeneity and to facilitate statistical evaluation, the relatively few male subjects and the few subjects with systemic JCA were excluded from the present report. Thus, only patients with
General condition of patients with JCA
The disease and its sequelae were most severe in the extended pauciarticular and polyarticular subtype of JCA (Table I). Twenty of the 43 participants had active JCA at the time of the study (47.6%). The general VAS pain scores ranged from 0 mm to 80 mm. Most patients had complete, or only mildly affected, functional ability (Steinbrocker functional class distribution I and II), but 3 patients (7.2%) had limited functional capacity or were largely or wholly incapacitated.
Description of orofacial findings in patients with JCA
Condylar lesions on the
Discussion
The patients with JCA in the present study most likely represented those most in need of hospital care after disease onset, because the study population from the start was referral-based.19 However, even with this possible bias toward the more severe cases, the high frequency of persistent disease demonstrates that the general prognosis for pauciarticular and polyarticular JCA can be unfavorable.
The polyarticular course of the disease was associated with the most “poor” disease outcome, both in
Conclusion
The present long-term follow-up study confirms that TMJ involvement is a frequent manifestation in patients with JCA. A majority of the patients experienced increased morbidity of reduced opening and biting abilities and orofacial pain due to TMJ involvement. The severity of these symptoms and signs was associated with long JCA duration and previous pain on jaw opening. Our findings suggest that all patients with JCA should undergo regular orofacial evaluation and that optimal disease control
Acknowledgements
We thank dental nurse Mrs Ana Vilaplana for her excellent help during the study.
References (39)
- et al.
Relationship between clinical and radiologic findings of the temporomandibular joint in rheumatoid arthritis
Oral Surg Oral Med Oral Pathol
(1988) - et al.
Epidemiology of headache in a general population—a prevalence study
J Clin Epidemiol
(1991) Heberden Oration, 1977. Chronic arthritis in childhood
Ann Rheum Dis
(1978)- et al.
Juvenile (rheumatoid) arthritis
- et al.
Epidemiology of juvenile chronic arthritis in South-western Sweden: A 5-year prospective population study
Pediatrics
(1992) - et al.
Juvenile chronic arthritis. A clinical and radiographic study of the chewing apparatus
Tandlaegernes Tidsskr
(1991) - et al.
Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study
Swed Dent J
(1991) - et al.
Mandibular condyle lesions related to age at onset and subtypes of juvenile rheumatoid arthritis in 15-year-old children
Scand J Dent Res
(1993) - et al.
Lesions of the mandibular condyle in juvenile chronic arthritis
Br J Orthod
(1996) - et al.
Bite force and temporomandibular disorder in juvenile chronic arthritis
J Oral Rehabil
(1995)
The temporomandibular joint in juvenile rheumatoid arthritis. Radiographic changes related to clinical and laboratory parameters in 100 children
Scand J Rheumatol
Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years
Eur J Orthod
Craniofacial growth in juvenile chronic arthritis
Acta Odontol Scand
Mandibular dysfunction in patients with juvenile rheumatoid arthritis
J Craniomandib Disord
Mandibular condyle lesions, jaw movements, and occlusal status in 15-year-old children with juvenile rheumatoid arthritis
Scand J Dent Res
Facial growth and oral function in a case of juvenile rheumatoid arthritis during an 8-year period
Eur J Orthod
Characteristics of masticatory movements and velocity in children with juvenile chronic arthritis
J Orofacial Pain
Mandibular growth, temporomandibular joint changes and dental occlusion in juvenile rheumatoid arthritis. A 17-year follow-up study
Scand J Rheumatol
Risk factors in juvenile chronic arthritis for developing temporomandibular disorders [abstract 3530]
J Dent Res
Cited by (57)
Evaluation of facial asymmetry in patients with juvenile idiopathic arthritis: Correlation between hard tissue and soft tissue landmarks
2018, American Journal of Orthodontics and Dentofacial OrthopedicsNo association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis
2018, American Journal of Orthodontics and Dentofacial OrthopedicsClinical predictors of temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic literature review
2016, Seminars in Arthritis and RheumatismCitation Excerpt :From a total of 345 unique citations, 21 articles complied with the inclusion and exclusion criteria were therefore included (Figure). The reasons for excluding full-text reviewed articles were studies without measureable or objective outcome variables [37–41], dual publications with the exception of meta-analyses [2,42,43], studies including insufficient imaging/x-ray modalities [4,44–47], articles mainly reporting on JIA patients older than 20 years of age [5,7,48], and the use of clinical indices where no singular outcome measures can be extrapolated from a score [49]. Due to the heterogeneity of the study designs and patient populations reported in the literature, we decided to subdivide and describe the findings in relation to the following three categories: (1) patients referred to a radiologist and/or dentist for consultation on suspicion of TMJ arthritis [20–24,29,31,33], (2) cross-sectional patient groups [15,19,25–28,30,32,35], and (3) newly diagnosed JIA patients (inception cohort) [12–14,34].
Juvenile idiopathic arthritis and the temporomandibular joint: A comprehensive review
2016, Journal of Cranio-Maxillofacial SurgerySystemic and intra-articular anti-inflammatory therapy of temporomandibular joint arthritis in children with juvenile idiopathic arthritis
2015, Seminars in OrthodonticsCitation Excerpt :Karhulahti et al.43 studied 121 JRA patients who were 15 years old, finding condylar flattening in 65 (55%) as well as decreased oral aperture in patients compared to healthy 15-year-old children. Important findings in several of these and other studies is that the risk of TMJ arthritis evident by radiography increases with prolonged disease duration, consistent with a cumulative effect of unopposed inflammation.44,45 This was illustrated most dramatically by Larheim and colleagues, who re-evaluated 60 of the original 103 subjects at a mean follow-up of 27 years.46
Jaw surgery for correction of dentofacial anomalies caused by JIA
2015, Seminars in Orthodontics
- *
Supported by The Danish Rheumatism Association, The Danish Hospital Foundation for Medical Research, the Region of Copenhagen, The Faroe Islands and Greenland, The Gangsted Foundation, and The Rosalie Petersen Foundation.
- **
Reprint requests: Merete Bakke, DDS, PhD, Dr Odont, Department of Oral Function and Physiology, School of Dentistry, University of Copenhagen, 20 Nørre Allé, DK-2200 Copenhagen, Denmark, [email protected]