Frequency and Morbidity of Temporomandibular Joint Involvement in Adult Patients with a History of Juvenile Idiopathic Arthritis

Publication date: Available online 2 December 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Rushil Dang, Lauren A. Henderson, David A. Zander, Kimberly M. Daniels, Peter A. Nigrovic, Leonard B. Kaban
PurposeThe majority of patients with juvenile idiopathic arthritis (JIA) have temporomandibular joint (TMJs) involvement, but little is known about the natural history of TMJ disease as these children enter adulthood. The purpose of this study is to evaluate adults with a history of JIA to document the frequency and severity of TMJ abnormalities and morbidity. We hypothesize that a majority will have persistent TMJ disease as adults.MethodsThis is a cross-sectional study including adults (>19 years-of-age) with JIA who were managed at Boston Children's Hospital (BCH) as children and at Brigham and Women's Hospital (BWH) as adults. History of a TMJ problem was not considered in enrollment. Subjects completed a questionnaire, physical examination and maxillofacial cone-beam computed tomography scan (CBCT). Additional data were obtained from medical records. Associations between TMJ abnormalities on CBCT and arthritis history, TMJ pain and function, facial asymmetry, malocclusion and cephalometric analysis were examined.ResultsOf 129 eligible patients contacted, 21 subjects (42 TMJs) were enrolled. The mean age was 26.0±6.1 years and mean duration of care for JIA at BCH/BWH was 13.7±6.5 years. TMJ pain was present in 62% (n=13) of patients; 43% (n=9) had a TMJ functional limitation and 76% (n=16) had a lower facial asymmetry. Abnormalities were found in the TMJs on 55% of CBCTs, with 79% demonstrating bilateral deformities. There was at least one cephalometric measurement of mandibular size or position that was more than one standard deviation beyond normal in 81% (n=17) of subjects. Only 4 subjects (19%) had previously been evaluated for a TMJ problem.ConclusionTMJ abnormalities and related morbidity are common in adult patients with a history of JIA. Therefore, an early screening protocol for TMJ involvement in children with a new diagnosis of JIA would be beneficial and long-term follow-up into adulthood should be routine.



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