Long-Term Outcome of Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis:Results of 18-Year Follow-up in the Population-Based Nordic JIA Cohort

Mia Glerup¹, Peter Stoustrup², Louise Hauge Matzen³, Veronika Rypdal^4,5, Ellen Nordal^5,6, Paula Frid^5,7, Ellen Dalen Arnstad^8,9, Marite Rygg^10,11, Olafur Thorarensen¹², Maria Ekelund^13,14, Lillemor Berntson¹⁵, Anders Fasth¹⁶, Håkan Nilsson¹⁷, Suvi Peltoniemi¹⁸, Kristiina Aalto¹⁸, Sirpa Arte¹⁹, Peter Toftedal²⁰, Susan Nielsen²⁰, Sven Kreiborg²¹, Troels Herlin²² and Thomas Klit Pedersen^23,24, ¹Department of Pediatrics, Dept. of Pediatrics, Aarhus University Hospital, Denmark, Aarhus, Denmark, ²Section of Orthodontics, Section of Orthodontics, Aarhus University, Denmark, Aarhus, Denmark, ³Department of Oral Radiology, Dept. of Oral Radiology, Aarhus University, Denmark, Aarhus, Denmark, ⁴Dept. of Pediatrics, University Hospital of North Norway, Tromsø, Norway, ⁵Department of Clinical Medicine, Dept. of Clin. Med, UIT The Arctic University of Norway, Tromsø, Norway, ⁶Departments of Pediatrics, Dept. of Pediatrics, University Hospital of North Norway, Tromsø, Norway, ⁷Division of Oral and Maxillofacial Surgery, ENT-Dept. and Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Centre of North Norway, Tromsø, Norway, ⁸Dep. Clin. and Mol. Med, Dept. Clin. and Mol. Med., NTNU, Norway, Trondheim, Norway, ⁹Department of Pediatrics, Dept. of Pediatrics, Levanger Hospital, Nord-Trøndelag, Norway, Trondheim, Denmark, ¹⁰Department of Pediatrics, Dept. of Pediatrics, St. Olavs Hospital, Norway, Trondheim, Norway, ¹¹Dep. Clin. and Mol. Med., Dept. Clin. and Mol. Med., NTNU, Norway, Trondheim, Norway, ¹²Dep. of oral and Craniomaxillofacial surgery, Dept. of oral and Craniomaxillofacial surgery, St. Olavs Hospital, Norway, NTNU, Trondheim, Norway, ¹³Department of Pediatrics, Dept. of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden, Jonkoping, Sweden, ¹⁴Uppsala University, Uppsala, Sweden, Jonkobing, Sweden, ¹⁵Uppsala University, Uppsala, Sweden, Uppsala, Sweden, ¹⁶Sahlgrenska Academy, University of Gothenburg, Sweden, Gothenburg, Sweden, ¹⁷Department of Oral and Maxillofacial Surgery, Dept. of Oral and Maxillofacial Surgery, The Institute for Postgraduate Dental Education, Jönköping, Sweden, Jonkoping, Sweden, ¹⁸Hospital for Children and Adolescents, University of Helsinki, Finland, Helsinki, Finland, ¹⁹Dept. of Oral and Maxillofacial Diseases, University of Helsinki, Finland, Helsinki, Finland, ²⁰Department of Pediatrics, Dept. of Pediatrics, Copenhagen University Hospital, Denmark, Copenhagen, Denmark, ²¹Dept. of Paediatric Dentistry and Clinical Genetics, University of Copenhagen, Denmark, Copenhagen, Denmark, ²²Dept. of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark, ²³Dept. of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark, ²⁴Section of Orthodontics, Aarhus University, Denmark, Aarhus, Denmark

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Juvenile idiopathic arthritis (JIA) and temporomandibular joint

Session Information

Date: Sunday, October 21, 2018

Title: 3S115 ACR/ARHP Abstract: Pediatric Rheum (976–981)

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Involvement of the temporomandibular joint (TMJ) is a common finding in patients with juvenile idiopathic arthritis (JIA), but the long-term outcome in a non-selected cohort remains unknown. The aims of the study were to assess the symptoms and dysfunction related to TMJ involvement in JIA compared to healthy controls and to describe the frequency of radiological TMJ abnormalities more than 17 years after disease onset.

Methods: From a Nordic, prospective, close to population-based, JIA cohort of 510 consecutive cases with disease onset between 1997 and 2000, 420 were eligible for orofacial evaluation of TMJ involvement.

The follow-up visit included demographic data and a standardized, clinical orofacial examination according to the consensus-based international recommendations¹ and a cone-beam computed tomography (CBCT). Two hundred age-matched healthy, Danish controls were used for comparison. IRB approval was granted.

Results: Out of 420 eligible JIA participants 265 (63%) participants were included (mean age 23.5 (±4.2) years). Of the 265 participants completing the clinical orofacial examination 245 had a full-face CBCT performed. The distribution of the JIA categories was as follows: 4% systemic, 21% persistent oligoarticular, 22% extended oligoarticular, 20% polyarticular RF negative, 2% polyarticular RF positive, 5% psoriatic, 10% enthesitis-related arthritis (ERA) and 17% undifferentiated JIA.

Orofacial symptoms: In 89/265 (33%) of the participants jaw or facial pain was reported within the last two weeks; of these 53% reported pain less than once a week and 27% reported Òseveral times per dayÓ or Òall the timeÓ. Compared to the controls, the participants with JIA had significantly more frequent orofacial pain (p=0.027). Of the 265 participants 87 (33%) reported at least one TMJ symptom including TMJ chewing pain, reduced chewing function, TMJ morning stiffness or locking of the TMJ within the last two weeks.

Orofacial dysfunction: Mean maximal incisal opening was significantly reduced in the JIA group (47.2 mm (±7.7)) when compared to the controls (56.5 mm (±6.8)) (p<0.001). An asymmetric mouth opening was found in 29/265 cases (11%).

Radiologic TMJ appearance: At least one abnormal radiologic appearance was found in 254/490 (52%) TMJs in150 participants. Only 95/245(39%) of the cases demonstrated normal bilateral CBCT findings (Table 1).

Conclusion:

To our knowledge, this is the first study on the long-term consequences of TMJ arthritis in a population-based JIA cohort.

1. The participants had significantly more often orofacial pain compared to controls.

2. Maximal incisal opening was significantly lower in the JIA participants.

3. 52% of the TMJs showed abnormal radiological appearance. Only 39% of the participants were without any TMJ abnormalities.

¹Stoustrup et al. J Rheumatol. 2017 Mar;44(3):326-333.

Disclosure: M. Glerup, None; P. Stoustrup, None; L. H. Matzen, None; V. Rypdal, None; E. Nordal, None; P. Frid, None; E. D. Arnstad, None; M. Rygg, None; O. Thorarensen, None; M. Ekelund, None; L. Berntson, None; A. Fasth, None; H. Nilsson, None; S. Peltoniemi, None; K. Aalto, None; S. Arte, None; P. Toftedal, None; S. Nielsen, None; S. Kreiborg, None; T. Herlin, None; T. K. Pedersen, None.

To cite this abstract in AMA style:

Glerup M, Stoustrup P, Matzen LH, Rypdal V, Nordal E, Frid P, Arnstad ED, Rygg M, Thorarensen O, Ekelund M, Berntson L, Fasth A, Nilsson H, Peltoniemi S, Aalto K, Arte S, Toftedal P, Nielsen S, Kreiborg S, Herlin T, Pedersen TK. Long-Term Outcome of Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis:Results of 18-Year Follow-up in the Population-Based Nordic JIA Cohort [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/long-term-outcome-of-temporomandibular-joint-arthritis-in-juvenile-idiopathic-arthritisresults-of-18-year-follow-up-in-the-population-based-nordic-jia-cohort/. Accessed .

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcome-of-temporomandibular-joint-arthritis-in-juvenile-idiopathic-arthritisresults-of-18-year-follow-up-in-the-population-based-nordic-jia-cohort/