Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA) is an autoimmune disorder of children and teenagers. It causes joint pain throughout the body, and also may affect other body systems. JIA leads to inflammation of joints. Its cause is unknown. There is no cure, but some treatments can cause remission of disease.

Interestingly, 40-90% of patients with JIA develop arthritis of the temporomandibular joint (TMJ). Symptoms include the presence of joint pain, dentofacial abnormalities, and functional problems with eating and talking. Females with JIA are three times more likely to develop arthritis of the TMJ than males. TMJ arthritis can have a negative impact on the quality of life for most patients.

Early diagnosis is challenging and may be missed because damage to the TMJ as measured by contrast-enhanced MRI does not always correlate well with symptomology. For example, the level of jaw pain does not always correlate well with tissue damage. Thus, a good clinical examination, jaw function measures, and imaging techniques are needed for diagnosis of this condition.

Treatment guidelines have been developed. Most lack high-quality scientific evidence, because a limited number of clinical studies have been completed and those studies usually enroll a small number of patients. Most are retrospective studies.

Initially, conservative treatments are recommended. These include the use of NSAIDS, maintaining a soft food diet, and physical therapy (PT), although PT may not be helpful in the long term.  The use of corticosteroids has shown some effectiveness in improving symptoms, but should be administered only once, because of complications with bone metabolism. In refractory cases, minimally invasive therapies, including arthrocentesis and arthroscopy, may be useful. Finally, surgical procedures may be attempted, but only in those rare patients who have exhausted all other treatments without success. However, once again, all these invasive treatments lack substantial scientific evidence of effectiveness.

A recent publication argues for an interdisciplinary approach to treatment for TMJ arthritis and outlines a future research agenda for the clinical management of TMJ arthritis. After an extensive literature survey, several consensus meetings, and multiple iterations of the Delphi process to reach 80% consensus, an interdisciplinary team of researchers developed  three management principles and 12 recommendations related to diagnosis and treatment of TMJ arthritis, dysfunction, and dentofacial deformities. These principles and recommendations fill a gap in current treatment for arthritis of the TMJ and lays out a template for other clinicians to follow in treating patients with other forms of TMD.