Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Department of Pediatrics, Division of Rheumatology, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
Pediatr Rheumatol Online J. 2024 Apr 8;22(1):41. doi: 10.1186/s12969-024-00968-2.
Temporomandibular joint (TMJ) involvement is an often underrecognized complication of juvenile idiopathic arthritis (JIA) that can cause decreased mandibular growth, altered facial morphology, and orofacial pain. It is estimated that the TMJ is affected in 30-45% of children with JIA. Standardized physical examination and imaging evaluations are important in accurately assessing active TMJ arthritis and sequalae. Little is known about the rate at which providers evaluate TMJ involvement in their clinical practice.
Data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. Data fields related to assessment for TMJ arthritis were added in 2019. Patients were included in the study if they had a diagnosis of JIA and had data recorded between January 2020 and August 2021. Standard descriptive statistics were used to describe demographic and clinical features.
A total of 17,761 visits were reviewed for a total of 7473 patients with JIA. A total of 52.7% of patients had maximal mouth opening (MMO) recorded as finger breadths or total incisal distance (TID). Only 8% had TID measured. A total of 5.0% had MRI with contrast performed. A total of 939 patients had a diagnosis of TMJ arthritis. Of these, 28.5% had an MRI documented, 83% had an MMO documented, and 40% had TID measured. Few patient-level characteristics were statistically related to having MMO assessed. MRI was more likely to be obtained in older and in female patients. MMO was recorded at a given visit > 80% of the time at 17 sites, and it was recorded < 1% of the time at 8 sites. MRIs were infrequently performed at all sites, with 27 sites having no MRIs obtained and only 7 sites having an MRI obtained at > 10% of visits.
MMO is not consistently measured in patients with JIA, and it is rarely measured quantitatively. Similarly, TMJ MRIs are rarely obtained in patients with JIA. Site of care is more associated with TMJ assessments than patient-level characteristics. These data suggest that provider education is needed to improve the assessment of the TMJ in patients with JIA to enable earlier recognition and prevent long-term complications.
颞下颌关节（TMJ）受累是幼年特发性关节炎（JIA）经常被低估的并发症，可导致下颌生长减少、面部形态改变和口颌疼痛。据估计，30-45%的 JIA 患儿的 TMJ 受到影响。标准化的体格检查和影像学评估对于准确评估活动性 TMJ 关节炎及其后遗症非常重要。关于提供者在临床实践中评估 TMJ 受累的频率知之甚少。
数据来自儿童关节炎和风湿病研究联盟（CARRA）登记处。2019 年增加了与 TMJ 关节炎评估相关的数据字段。如果患者患有 JIA 且在 2020 年 1 月至 2021 年 8 月期间有数据记录，则将其纳入研究。使用标准描述性统计描述人口统计学和临床特征。
共回顾了 17761 次就诊，共 7473 例 JIA 患者。记录最大张口度（MMO）的患者中，52.7%记录为指宽或总切牙距离（TID）。仅 8%测量了 TID。5.0%的患者进行了 MRI 增强检查。共诊断出 939 例 TMJ 关节炎患者。其中，28.5%的患者有 MRI 记录，83%的患者有 MMO 记录，40%的患者有 TID 测量。很少有患者特征与 MMO 评估有关。年龄较大和女性患者更有可能获得 MRI。在 17 个地点，MMO 在特定就诊时的记录率>80%，而在 8 个地点的记录率<1%。所有地点的 MRI 检查都很少进行，27 个地点未进行 MRI 检查，只有 7 个地点在>10%的就诊时进行 MRI 检查。
JIA 患者的 MMO 未得到一致测量，且很少进行定量测量。同样，JIA 患者很少进行 TMJ MRI 检查。就诊地点与 TMJ 评估的相关性大于患者特征。这些数据表明，需要对提供者进行教育，以改善 JIA 患者 TMJ 的评估，从而更早地发现并预防长期并发症。
