Impaired mandibular growth and micrognathic development in children with juvenile rheumatoid arthritis. A longitudinal study of lateral cephalographs.

The present report is a longitudinal study of the craniofacial growth, based on lateral cephalographs of a group of 26 patients with juvenile rheumatoid arthritis (JRA), and a matched English control group. In the 26 matched pairs, the mean age at baseline was 8.4 years and at 6-year follow-up 14.7 years, female/male ratio was 3.3/1, and all patients had temporomandibular joint (TMJ) abnormalities. The study revealed obvious growth disturbances in the facial skeleton in the children with JRA. Compared with the controls, the patients showed a smaller mandible with an altered morphology and position. The mandible became more retruded by rotating posteriorly, around a centre in the molar region, and was characterized by appositional growth in the gonion area, vertical growth in the anterior part and proclination of the lower incisors. During the observation period the growth disturbances became more pronounced, reflecting the progressive nature of the abnormal development. Based on these findings, a future aspect of research in this field could be TMJ surgery and orthognathic surgery in an early stage, trying to avoid this unfavourable facial development.