Abstract
Objective: Juvenile idiopathic arthritis (JIA) is a common, chronic and inflammatory rheumatological disease of childhood. The disease can affect all synovial joints in the body. Temporomandibular joints (TMJs) are important areas of involvement in JIA, which are frequently involved but often not noticed because the involvement is usually asymptomatic. The aim of this study is to determine the frequency and risk factors of TMJ joint involvement in juvenile idiopathic arthritis patients admitted to our clinic, and to guide for early diagnosis and treatment.
Methods: Patients who applied to this study with the diagnosis of JIA between January 2014 and May 2017 at Pediatric Rheumatology Clinic, were followed up regularly in our clinic, had a accessible medical history, and a rheumatology polyclinic record. Patients with contrast-enhanced TMJ Magnetic Resonance Imaging (MRI) taken and reported by the radiologist were included.
Results: TMJ involvement was detected in 51.2% of the 41 patients included in the study. It was found that 71.5% of the patients with TMJ involvement were asymptomatic and 71.5% of the patients had chronic involvement. When the patients with and without TMJ involvement were compared according to the contrast-enhanced TMJ MRI results; In the patient group with involvement, the polyarticular onset subtype was seen at a higher rate (p=0.005), the age of onset was earlier (p=0.003), the disease duration was longer (p=0.037), more joints were involved (p=0.005), the ESR values were higher (p=0.0001), and the treatment compliance and treatment responses of the patients in this group were worse (p=0.001, p=0.0001).
Conclusion: TMJ involvement is common in JIA patients. TMJs can be involved at any stage of the disease, the involvement is usually asymptomatic and progresses insidiously, causing chronic, degenerative changes in the mandibule in early period. Because TMJ involvement is asymptomatic, shows insidious progression, can lead to chronic irreversible sequelae, and precise risk factors cannot be determined, all JIA patients should be screened with contrast enhanced TMJ MRI at regular intervals, which is the gold standard method.