Magnetic Resonance Imaging Followup of Temporomandibular Joint Inflammation, Deformation, and Mandibular Growth in Juvenile Idiopathic Arthritis Patients Receiving Systemic Treatment

Abstract

Objective.To investigate the course of temporomandibular joint (TMJ) inflammation, osseous deformation, and mandibular ramus growth in children with juvenile idiopathic arthritis (JIA) during systemic therapy.Methods.Longitudinal study of 38 consecutive patients with JIA (29 female, median age 9.0 yrs, interquartile range 6.2–10.7 yrs) receiving systemic therapy with TMJ involvement, with 2 TMJ magnetic resonance imaging (MRI) examinations ≥ 2 years apart and no TMJ corticosteroid injection. Clinical and MRI findings were compared between initial and followup examinations and between TMJ with and without active inflammation at baseline.Results.Over a median period of 3.6 years (range, 2.0–8.7 yrs), MRI grade of TMJ inflammation improved (p = 0.009) and overall osseous deformity tended to become less severe (p = 0.114). In TMJ with arthritis at baseline (46 TMJ), both the grades of inflammation (p < 0.001) and deformity (p = 0.011) improved. In TMJ with no arthritis at baseline (30 TMJ), the frequency and grade of condylar deformation remained stable. Mandibular ramus growth rates were not significantly different between TMJ with and without arthritis at baseline (1.3 mm/yr vs 1.5 mm/yr, p = 0.273), and were not correlated with the degree of inflammation at baseline or followup. The frequency of facial asymmetry tended to be lower at followup than at initial examination (24% vs 45%, p = 0.056).Conclusion.Our results suggest that systemic treatment of TMJ arthritis in children with JIA decreases the degree of inflammation seen on MRI, preserves osseous TMJ morphology, and maintains normal mandibular ramus growth.