Compromised mandibular function in juvenile idiopathic arthritis

Abstract

This thesis examines the clinical approach to recognizing temporomandibular joint (TMJ) problems in patients with juvenile idiopathic arthritis (JIA). The study found a high prevalence of TMJ involvement, affecting 30.9% of children and 56% of adults with JIA. These findings highlight the importance of routine TMJ assessments in JIA patients during the follow-up in children with JIA. Rather than relying on MRI, the current gold standard, this thesis utilized clinical examinations to assess TMJ involvement. The reliability of the existing TMJ-MRI scoring system, 'JAMRIS -TMJ,' was found to be unsatisfactory, casts doubt on whether the JAMRIS-TMJ is a true gold standard for detecting TMJ arthritis in children with JIA. Clinical examination is a noninvasive and practical method for identifying and monitoring TMJ involvement. A key aspect of the clinical assessment is the active maximum interincisal opening (AMIO) measurement, which is reliable, easy to perform, and widely used. AMIO is also significantly influenced by JIA and TMJ involvement. Additionally, anterior maximum voluntary bite force (AMVBF) was evaluated, showing a 24.0% reduction in children with JIA compared to healthy children. A greater reduction (32.2%) was observed in children with JIA and TMJ involvement. However, AMVBF did not differ in adults with and without TMJ involvement, suggesting its limited use in screening for TMJ issues in adult JIA patients. It’s emphasizes that a single clinical variable may not be sufficient for TMJ assessment. Instead, a comprehensive clinical examination, such as the TMJ screening protocol used in this thesis, offers a more sensitive approach for detecting TMJ involvement.