Background/Purpose: The temporomandibular joint (TMJ) can be affected in juvenile idiopathic arthritis (JIA) patients of any age or subtype. There have been reports of isolated TMJ arthritis. Idiopathic condylar resorption (ICR) and anterior disc displacement (ADD) also affect the TMJ and can be difficult to distinguish from JIA. The MRI appearance of active JIA-associated TMJ arthritis shows significant overlap with patients diagnosed with ADD. A Swiss study showed various degrees of inflammation with joint effusion, synovial thickening, and joint enhancement in both patients with JIA and ADD. Rheumatologists are increasingly asked to see patients with isolated TMJ problems. The confidence level of rheumatologists regarding differentiation between these different conditions is unclear. Interested researchers from the Temporomandibular Jaw working group (TMJaw) and the Childhood Arthritis Rheumatology Research Alliance (CARRA) TMJ interest group surveyed pediatric rheumatologist to assess the burden of isolated TMJ referrals and their confidence level in differentiating these conditions.

Methods: A survey was developed that had both closed and open-ended questions. This survey was distributed to a group of pediatric rheumatologist CARRA members. Participants were asked to identify areas of opportunity in this area including: Increasing awareness among rheumatologists on the different diagnosis, increasing awareness among radiologists, and development of algorithms to help assist to differentiate these conditions. Descriptive statistics were used.

Results: In total, 93 individuals participated in the survey, 94.5% (88) self-identified as pediatric rheumatologists, 5.5% (5) individuals were combined pediatric/adult rheumatologists. On average most of the participants see between 1-5 patients per year for the question of isolated JIA-associated TMJ arthritis. The majority of respondents rated themselves as somewhat confident in evaluating isolated TMJ concerns in children. Survey participants had seen both ICR and ADD patients and felt mostly minimally confident in differentiating between ICR and TMJ arthritis for both mimickers. The majority of participants stated that they have a team to discuss these cases with, most teams included a radiologist or oral and maxillofacial surgeon.

Conclusion: According to the results of this survey, pediatric rheumatologists have an overall level of discomfort regarding differentiation of TMJ mimickers, as many participants stated that they were minimally or somewhat confident in most circumstances at diagnosing these mimickers. However, many participants stated that they have assistance from a multidisciplinary team in aiding them with these diagnoses and mainly this includes a dedicated radiologist. These results highlight the need for additional research to help providers differentiate between these disparate TMJ conditions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/jia-associated-tmj-arthritis-idiopathic-condylar-resorption-or-anterior-disc-displacement-a-care-provider-survey/