Temporomandibular Joint Involvement and Juvenile Idiopathic Arthritis
Juvenile Idiopathic Arthritis (JIA) is one of the most common forms of arthritis generating joint inflammation and stiffness for more than 6 weeks in a child aged 16 or younger. In US alone, it effects about 50,000 children. A study was performed to estimate the demographic, disease activity, disability and health-related quality of life (HRQoL) differences between children with JIA and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants.
The study involved 343 children with JIA and 3409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organization (PRINTO) health-related quality of life (HRQoL) study or in the methotrexate trial. The potential determinants of TMJ involvement comprised of demographic, disease activity, disability and HRQoL measures chosen through univariate and multivariable logistic regression.
The clinical TMJ involvement was seen in 387/3343 (11.6%) JIA children. The children suffering from TMJ involvement to those without, more often experienced from polyarticular disease course (95% versus 70%), more disability, lower HRQoL and higher Juvenile Arthritis Disease Activity Score (JADAS) (odds ratio (OR) 4.6). Children with TMJ involvement evidently had more disability and lower HRQoL as compared to their healthy peers. The multivariable analysis, revealed that cervical spine involvement (OR 4.6), disease duration > 4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most significant determinants for TMJ involvement.
It was interpreted that the clinical TMJ involvement in JIA is related with higher disease activity, higher disability and impaired HRQoL. These results also pointed out the urge for dedicated clinical and imaging evaluation of TMJ arthritis especially in children with cervical spine involvement, polyarticular course and longer disease duration.