School of Medicine, Division of Pediatric Allergy and Immunology, Recep Tayyip Erdogan University, Rize, Türkiye.
Division of Pediatric Rheumotology, Center of Duzce, Duzce University School of Medicine, Yorukler Street, Konuralp Neighborhood, 81620, Duzce, Türkiye.
Pediatr Rheumatol Online J. 2024 Nov 25;22(1):101. doi: 10.1186/s12969-024-01031-w.
Juvenile idiopathic arthritis (JIA) is a common, chronic and inflammatory rheumatological disease of childhood. The disease can affect all synovial joints in the body. Temporomandibular joints (TMJs) are important areas of involvement in JIA, which are frequently involved but often not noticed because the involvement is usually asymptomatic. The aim of this study is to determine the frequency and risk factors of TMJ joint involvement in juvenile idiopathic arthritis patients admitted to our clinic, and to guide for early diagnosis and treatment.
Patients who applied to this study with the diagnosis of JIA between January 2014 and May 2017 at Pediatric Rheumatology Clinic, were followed up regularly in our clinic, had a accessible medical history, and a rheumatology polyclinic record. Patients with contrast-enhanced TMJ Magnetic Resonance Imaging (MRI) taken and reported by the radiologist were included.
TMJ involvement was detected in 51.2% of the 41 patients included in the study. It was found that 71.5% of the patients with TMJ involvement were asymptomatic and 71.5% of the patients had chronic involvement. When the patients with and without TMJ involvement were compared according to the contrast-enhanced TMJ MRI results; In the patient group with involvement, the polyarticular onset subtype was seen at a higher rate (p = 0.005), the age of onset was earlier (p = 0.003), the disease duration was longer (p = 0.037), more joints were involved (p = 0.005), the ESR values were higher (p = 0.0001), and the treatment compliance and treatment responses of the patients in this group were worse (p = 0.001, p = 0.0001).
TMJ involvement is common in JIA patients and can occur at any stage of the disease. It is often asymptomatic and progresses insidiously, leading to chronic and degenerative changes in the mandible at an early stage. Due to its asymptomatic nature, the insidious progression, and the risk of causing chronic, irreversible sequelae, it is crucial to screen high-risk JIA patients regularly with contrast-enhanced TMJ MRI, which remains the gold standard method. While specific risk factors are difficult to pinpoint, some factors may increase the likelihood of TMJ involvement. To better identify these high-risk patients and determine which individuals require regular screening, larger-scale and multicenter studies are essential.
幼年特发性关节炎（JIA）是一种常见的慢性炎症性儿童风湿病。这种疾病会影响全身所有滑膜关节。颞下颌关节（TMJ）是 JIA 的重要受累部位，常受累但常被忽视，因为受累通常无症状。本研究旨在确定我院就诊的幼年特发性关节炎患者 TMJ 关节受累的频率和危险因素，并为早期诊断和治疗提供指导。
2014 年 1 月至 2017 年 5 月在我院儿科风湿病科就诊并诊断为 JIA 的患者申请本研究，在我院定期随访，有可及的病史和风湿病门诊记录。包括由放射科医生拍摄并报告的对比增强 TMJ 磁共振成像（MRI）的患者。
在纳入的 41 名患者中，有 51.2%的患者发现 TMJ 受累。发现 71.5%的 TMJ 受累患者无症状，71.5%的患者为慢性受累。当根据对比增强 TMJ MRI 结果比较有和无 TMJ 受累的患者时；在受累的患者组中，多关节发病亚型的发生率更高（p=0.005），发病年龄更早（p=0.003），疾病持续时间更长（p=0.037），受累关节更多（p=0.005），ESR 值更高（p=0.0001），该组患者的治疗依从性和治疗反应更差（p=0.001，p=0.0001）。
TMJ 受累在 JIA 患者中很常见，可发生在疾病的任何阶段。它通常无症状，且进展隐匿，导致下颌早期出现慢性退行性改变。由于其无症状性质、隐匿性进展以及导致慢性不可逆后遗症的风险，定期使用对比增强 TMJ MRI 对高危 JIA 患者进行筛查至关重要，这仍然是金标准方法。虽然具体的危险因素难以确定，但某些因素可能会增加 TMJ 受累的可能性。为了更好地识别这些高危患者并确定哪些个体需要定期筛查，需要进行更大规模和多中心的研究。
