Juvenile idiopathic arthritis and the temporomandibular joint

Background: The temporomandibular joint (TMJ) is one of the most underdiagnosed and undertreated conditions of juvenile idiopathic arthritis (JIA) because its involvement is often asymptomatic and the joint is difficult to examine. Objectives: The aim of this study was to investigate clinical as well as magnetic resonance imaging findings of temporomandibular joint inflammation among juvenile idiopathic arthritis patients and to detect the correlation between them, moreover with different disease parameters. Methods: Forty patients with JIA and 10 apparently healthy control subjects underwent clinical and post contrast magnetic resonance imaging (MRI) examinations for TMJs. MRI findings were scored. Clinical and laboratory disease parameters were recorded. Results: The clinical symptoms and signs of TMJ arthritis were detected in 35% and 62.5% of JIA cases, respectively. While TMJ disease was observed in 80% of patients using contrast enhanced MRI. The mean total MRI score was significantly higher in patients with active disease compared to those without activity. Patients with systemic and polyarticular JIA showed significant increase in the mean of synovial enhancement, effusion and total MRI scores compared to those with the oligoarticular type. MRI abnormalities revealed significant association with clinical signs of TMJ examination but not with symptoms. Synovial enhancement score showed significant positive correlation with disease activity score and C-reactive protein as a marker of inflammation. A significant positive correlation was found between total MRI score and disease activity, functional and pain scores in patients with JIA. Conclusions: TMJ arthritis is common among patients with JIA, therefore; examination of the TMJ is mandatory during the follow up of patients. Clinical signs of TMJ arthritis can be used as filter for MRI examination TMJ is an important joint which may be considered during categorizing JIA patients in different subtypes. (C) 2011 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. All rights reserved.