Juvenile idiopathic arthritis (JIA), also known as juvenile chronic arthritis and juvenile rheumatoid arthritis affects a range of joints. The temporomandibular joint (TMJ) can be the first and only affected joint. In the UK about 1 and 2 in every 10,000 children develop JIA each year. The prevalence of TMJ involvement in JIA patients ranges for 17-87%. The aim of this review was to assess the literature on the treatment of patients with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement.
Searches were conducted in the Embase, Medline OvidSP, Cochrane CENTRAL, CINAHL, Web of Science, and PubMed databases. The reference lists of all articles were screened for additional relevant sources. Two reviewers carried out study selection independently. English language studies describing treatment for JIA were included.
- 40 articles were included. There were no clinical trials. The majority were retrospective case series or reports.
- Treatments were broadly divided into two groups an arthritis group and a Dentofacial deformity group.
- In the arthritis group treatments were aimed at control and prevention of further progression and included local and systemic pharmacologic interventions, physical therapy, oral appliance, functional appliance, surgery, or a combination of therapies.
- In the dentofacial group treatment focused on restoration of function and included an range of surgical procedures, distraction splints, combined orthodontic and surgical approaches and total joint prosthesis.
The authors concluded
Systemic treatment to control the TMJ involvement in children with JIA is suggested; however, evidence is lacking. Treatment goals to improve aesthetics and function and to reduce pain showed acceptable results. However, because the articles are heterogeneous, no definitive conclusions can be drawn, and more research is necessary. The general quality of the literature is suboptimal, and there is a need for higher-quality studies with well-defined patient populations and examination techniques.
Comment
The authors have searched a broad range of databases and unfortunately have only identified a wide range of poor quality retrospective studies to address this question. While their inclusion criteria an not clearly described they appear to have taken a broad view in order to identify what information is available on this topic. The authors point out that many of the studies do not describe the extent to the disease in the patients and the heterogeneity of the treatments and regimes utilised also makes comparisons difficult. So while this review does provide a helpful summary of the treatments have been used it is clear that high quality randomised controlled trials to properly compare the available treatment to improve patient care.
We have previously reported a review that looked only at the use of intra articular steroids for JIA patients ( Dental Elf 1st Feb 2013). That review included 7 studies one of which was prospective although all 7 were considered at high risk of bias. A small number of Cochrane reviews are available related to the wider management of JIA and while some RCTs are available they a similarly few in number.
Links
te Veldhuis EC, te Veldhuis AH, Koudstaal MJ. Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014 May;117(5):581-589.e2. doi: 10.1016/j.oooo.2014.01.226. Epub 2014 Feb 6. PubMed PMID: 24650371.
Takken T, van der Net JJ, Helders PPJM. Methotrexate for treating juvenile idiopathic arthritis. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003129. DOI: 10.1002/14651858.CD003129.
Wallen MM, Gillies D. Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD002824. DOI: 10.1002/14651858.CD002824.pub2.
Takken T, Van Brussel M, Engelbert RH, van der Net JJ, Kuis W, Helders PPJM. Exercise therapy in juvenile idiopathic arthritis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD005954. DOI: 10.1002/14651858.CD005954.pub2.
