青少年特发性关节炎颞下颌关节的长期转归：北欧青少年特发性关节炎队列的 17 年随访
Longterm Outcomes of Temporomandibular Joints in Juvenile Idiopathic Arthritis: 17 Years of Followup of a Nordic Juvenile Idiopathic Arthritis Cohort.
机构信息
From the Department of Pediatrics, Aarhus University Hospital; Section of Orthodontics, Aarhus University; Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Department of Pediatrics, University Hospital of North Norway, Tromsø; Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø; Department of Otorhinolaryngology and Department and Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Center of North Norway, Tromsø; Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim; Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger; Department of Pediatrics, St. Olavs Hospital, Trondheim; Department of Oral and Craniomaxillofacial Surgery, St. Olavs Hospital, Trondheim, Norway; Department of Pediatrics, Ryhov County Hospital, Jönköping; Department of Women's and Children's Health, Uppsala University, Uppsala; Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg; Department of Oral and Maxillofacial Surgery/Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, Sweden; Hospital for Children and Adolescents, University of Helsinki, Helsinki; Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Pediatrics, Copenhagen University Hospital, Copenhagen; Department of Pediatric Dentistry and Clinical Genetics, University of Copenhagen, Copenhagen; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
M. Glerup, MD, Department of Pediatrics, Aarhus University Hospital; P. Stoustrup, Associate Professor, DDS, PhD, Section of Orthodontics, Aarhus University; L.H. Matzen, DDS, PhD, Associate Professor, Section of Oral Radiology, Department of Dentistry and Oral Health, Aarhus University; V. Rypdal, MD, Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; E. Nordal, MD, PhD, Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway; P. Frid, DDS, Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, and Department of Otorhinolaryngology and Department and Division of Oral and Maxillofacial Surgery, University Hospital North Norway and Public Dental Service Competence Center of North Norway; E.D. Arnstad, MD, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, and Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust; M. Rygg, MD, Professor, PhD, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, and Department of Pediatrics, St. Olavs Hospital; O. Thorarensen, DDS, Department of Oral and Craniomaxillofacial Surgery, St. Olavs Hospital; M. Ekelund, MD, Department of Pediatrics, Ryhov County Hospital, and Department of Women's and Children's Health, Uppsala University; L. Berntson, MD, PhD, Department of Women's and Children's Health, Uppsala University; A. Fasth, MD, PhD, Professor, Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg; H. Nilsson, DDS, PhD, Dr. Odont, Department of Oral and Maxillofacial Surgery/Stomatognathic Physiology, The Institute for Postgraduate Dental Education; S. Peltoniemi, MD, Hospital for Children and Adolescents, University of Helsinki; K. Aalto, MD, PhD, Hospital for Children and Adolescents, University of Helsinki; S. Arte, DDS, PhD, Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital; P. Toftedal, MD, PhD, Department of Pediatrics, Copenhagen University Hospital; S. Nielsen, MD, Department of Pediatrics, Copenhagen University Hospital; S. Kreiborg, Professor, DDS, PhD, Dr. Odont, Department of Pediatric Dentistry and Clinical Genetics, University of Copenhagen; T. Herlin, Professor, MD, DMSc, Department of Pediatrics, Aarhus University Hospital; T.K. Pedersen, Professor, DDS, PhD, Section of Orthodontics, Aarhus University, and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital.
出版信息
J Rheumatol. 2020 May 1;47(5):730-738. doi: 10.3899/jrheum.190231. Epub 2019 Sep 15.
OBJECTIVE
To determine the prevalence of orofacial symptoms, dysfunctions, and deformities of the temporomandibular joint (TMJ) in juvenile idiopathic arthritis (JIA) 17 years after disease onset.
METHODS
Drawn from a prospective, population-based Nordic JIA cohort with disease onset from 1997 to 2000, 420 consecutive cases were eligible for orofacial evaluation of TMJ involvement. The followup visit included demographic data, a standardized clinical orofacial examination, and full-face cone-beam computed tomography (CBCT). For comparison, 200 age-matched healthy controls were used.
RESULTS
Of 420 eligible participants with JIA, 265 (63%) were included (mean age 23.5 ± 4.2 yrs) and completed a standardized clinical orofacial examination. Of these, 245 had a full-face CBCT performed. At least 1 orofacial symptom was reported by 33%. Compared to controls, the JIA group significantly more often reported TMJ pain, TMJ morning stiffness, and limitation on chewing. Further, among participants reporting complaints, the number of symptoms was also higher in JIA. The mean maximal incisal opening was lower in the JIA group (p < 0.001), and TMJ pain on palpation was more frequent. Condylar deformities and/or erosions were observed in 61% as assessed by CBCT, showing bilateral changes in about 70%. Risk factors of condylar deformities were orofacial dysfunction or biologic treatment; enthesitis-related arthritis was protective.
CONCLUSION
This study of the longterm consequences of TMJ involvement in a population-based JIA cohort reports persistence of comprehensive symptoms, dysfunctions, and damage of the TMJ into adulthood. We suggest interdisciplinary followup of JIA patients also in adulthood.
目的
在发病 17 年后，确定青少年特发性关节炎（JIA）患者的颞下颌关节（TMJ）的口腔症状、功能障碍和畸形的患病率。
方法
本研究从 1997 年至 2000 年发病的前瞻性、基于人群的北欧 JIA 队列中抽取 420 例连续病例，对 TMJ 受累情况进行口腔评估。随访包括人口统计学数据、标准化临床口腔检查和全脸锥形束 CT（CBCT）。为了进行比较，使用了 200 名年龄匹配的健康对照者。
结果
在 420 名符合条件的 JIA 参与者中，有 265 名（63%）符合条件并完成了标准化临床口腔检查（平均年龄 23.5±4.2 岁）。其中 245 名接受了全脸 CBCT 检查。33%的患者报告至少有 1 种口腔症状。与对照组相比，JIA 组患者更常报告 TMJ 疼痛、TMJ 晨僵和咀嚼受限。此外，在报告有症状的参与者中，JIA 组的症状数量也更多。JIA 组的最大切牙开口平均值较低（p<0.001），TMJ 触诊疼痛更为频繁。CBCT 评估显示，61%的患者观察到髁突畸形和/或侵蚀，约 70%的患者表现为双侧改变。髁突畸形的危险因素是口腔功能障碍或生物治疗；附着点炎相关关节炎则具有保护作用。
结论
本研究对基于人群的 JIA 队列中 TMJ 受累的长期后果进行了研究，报告称 TMJ 的全面症状、功能障碍和损伤持续到成年期。我们建议对成年 JIA 患者也进行多学科随访。
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