Search

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA. publishedVersion

Objective - To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. Material and methods - In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10–16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. Results - 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 − 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 − 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. Conclusions - Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Additional file 10. Table S1. Disease-specific features and dental caries in relation to the outcome variable Early Childhood Oral Health Impact Scale (ECOHIS) total score and Child Oral Impacts on Daily Performance (Child-OIDP) simple count (SC) score. Unadjusted and adjusted negative binominal regressions.

Additional file 8. Table S1. Discriminant validity of the Early Childhood Oral Health Impact Scale (ECOHIS) and Child Oral Impacts on Daily Performances (Child-OIDP) according to the global measures and group affiliation.

Additional file 2. Calibration.

Additional file 4: Supplemental file S4. Additional adjustments in the regression analyses.

Additional file 2: Supplemental file S2. Oral health assessments.

Additional file 3: Supplemental file S3. Dietary and supplemental vitamin D intake.

Additional file 5. Table S1. Categories for Child Oral Impacts on Daily Performances (Child-OIDP) (12–16 years) and questions regarding satisfaction with oral health (global measures), as originally coded and as re-coded for analyses.

Additional file 7. Table S1. Categories for JIA-specific background variables, as originally coded and re-coded for analyses.

Additional file 6. Description of JIA-specific background variables.

Additional file 1: Supplemental file S1. Calibration.

Additional file 2. Table S1. Concomitant diagnoses and medication use among individuals with JIA and the controls that are a potential oral health threat.

Additional file 6: Table S1. Illustration of the levels in the multilevel models, according to the dichotomous caries outcome variable and background variables.

Additional file 4. Elaboration of the JIA-specific clinical background variables, collected by the pediatric rheumatologists

Additional file 5. Calibration

Additional file 1. Sample size calculation

Additional file 3: Table S1A. Categories for sociodemographic and behavioral characteristics (4–16 years), as originally coded and as re-coded for analyses. Table S1B. Categories for behavioral characteristics (

The temporomandibular joint (TMJ) is commonly involved in juvenile idiopathic arthritis (JIA), and may lead to impaired mouth opening, pain and facial growth disturbances. Asymptomatic TMJ arthritis may be diagnosed late in the disease course, thus management is challenging. The overall objectives of this thesis were to provide new knowledge on quality of life (QoL), the oral microbiome and interventions in children with JIA and TMJ arthritis. Cross-sectional and observational multicenter studies were performed in addition to a systematic literature review. The present work showed lower QoL scores in children with JIA and TMJ arthritis compared to those without TMJ arthritis, and healthy controls. Clinicians should pay special attention to TMJ involvement in children with cervical spine involvement, younger age at onset, polyarticular course and longer duration of JIA. Microbiota associated with chronic inflammation in saliva is more common in JIA compared to healthy children and some of these bacteria were associated with increased disease activity in JIA. Regular dental follow-ups with special concern to oral hygiene and infections may therefore be recommended in children with JIA. Single corticosteroid injections in adolescents with JIA and TMJ arthritis may be efficient as a supplement to systemic treatment; we found reduced inflammation, slightly improved mouth opening and no side effects, but pain was not significantly reduced. Finally, surgical intervention of dentofacial deformities in patients with JIA can be recommended for improvement of TMJ function and skeletal alignment, even if the level of evidence in existing studies are low.

Additional file 1: Supplementary Table 1. Magnetic resonance imaging (MRI) protocol for adolescents with juvenile idiopathic arthrtitis (JIA) and temporomandibular joint (TMJ) arthritis receiving intraarticular corticosteroids (IACs).

Additional file 1: Table S1. Search history

To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants.This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression.Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index0.625) (OR 1.6) were the most important determinants for TMJ involvement.Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.

980 Abstract Number 980