Temporomandibular Pain in Patients with Juvenile Idiopathic Arthritis

Peter Stoustrup¹, Marinka Twilt², Bernd Koos³, N Tzaribachev⁴, Troels Herlin⁵, Thomas Klit Pedersen⁶ and Lynn R. Spiegel⁷, ¹Section of Orthodontics, University of Aarhus, Aarhus C, Denmark, ²Pediatric Rheumatology, Aarhus University Hospital, Aarhus, Denmark, ³Orthodontics, University of Rostock, Rostock, Germany, ⁴Pediatric Rheumatology, PRI - Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany, ⁵Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark, ⁶orthodontics, Aarhus University Hospital/Dental school, Aarhus, Denmark, ⁷Rheumatology/Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: juvenile idiopathic arthritis (JIA), pain, pediatric rheumatology and temporomandibular joint

Session Information

Date: Monday, November 9, 2015

Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects Posters. Juvenile Arthritis and Miscellaneous Rheumatic Diseases

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Joint pain is a primary symptom in Juvenile Idiopathic Arthritis (JIA). Experience of pain has been shown to be a significant predictor of impaired physical and psychosocial function. Although pain in JIA overall is a well-known feature and pain-related beliefs were significantly associated with pain in children with JIA, perception and impact of pain of the temporomandibular joint (TMJ) in patients with JIA is not well researched. Therefore a TMJ specific pain questionnaire was developed by the Clinical Recommendation group of euroTMjoint, an international network established in 2010 to enhance multidisciplinary, multicenter TMJ research in JIA. The aim of this study is to report the frequency and pattern of pain in the TMJ area and describe the impact on TMJ function.

Methods:

A specific TMJ pain questionnaire was developed based on a Delphi study and systematic review. The following items were incorporated: pain frequency; pain intensity; pain location; TMJ function; TMJ symptoms; changes in facial or TMJ pain since last visit; changes in TMJ function since last visit. All consecutive JIA patients visiting one orthodontic clinic in Aarhus, Denmark, were included.

Results:

180 patients were approached to participate in the study. All patients agreed, however 8 did not complete the questionnaire, and were therefore excluded. 172 questionnaires were included. 58% (100/172) of patients reported the presence of TMJ pain with a median VAS of 3.6 (range 0.4-8.9). Imaging of the TMJ (CBCT or MRI) was available in 112 of the 172 patients (65%); 69% in patients with TMJ pain and 60% in patients without TMJ pain. Evidence of TMJ involvement on imaging was present in 61/69 (88%) of patients with TMJ pain and in 34/43 (79%) of patients without TMJ pain. The most frequent orofacial pain location was the masseter area followed by the TMJ region (58% and 46% respectively); and in both the masseter and TMJ regions in 15% of patients.Patients with TMJ pain reported significantly more functional problems, such as difficulty chewing, than those without pain. (70% compared to 7%, p<0.0001).

Conclusion:

More than half of JIA patients experience orofacial pain. Most frequently this involves the masseter and TMJ region. TMJ pain seems to be more frequent in patients with TMJ pathology on imaging, however is also present when imaging is normal. Pain in the TMJ area is significantly correlated with functional TMJ problems.

Disclosure: P. Stoustrup, None; M. Twilt, None; B. Koos, None; N. Tzaribachev, UCB, Pfizer, Janssen, Roche, 2; T. Herlin, None; T. K. Pedersen, None; L. R. Spiegel, None.

To cite this abstract in AMA style:

Stoustrup P, Twilt M, Koos B, Tzaribachev N, Herlin T, Pedersen TK, Spiegel LR. Temporomandibular Pain in Patients with Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/temporomandibular-pain-in-patients-with-juvenile-idiopathic-arthritis/. Accessed .

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