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- Cedströmer, Anna-Lena, 1974, et al.
(författare)
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Temporomandibular signs, symptoms, joint alterations and disease activity in juvenile idiopathic arthritis – an observational study
- 2013
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 11:37
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Juvenile idiopathic arthritis (JIA) is a heterogeneous disease that frequently affects also the temporomandibular joint (TMJ) and associated structures. The main aim of this observational study was to describe systematically orofacial clinical signs and subjective symptoms in JIA patients, classified according to the International League of Associations for Rheumatology (ILAR) criteria, and to relate the findings to disease activity and radiological TMJ condyle lesions. METHODS: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to one of three dental specialist clinics in Sweden during an eight-year period. Data concerning temporomandibular signs, symptoms and general disease activity were collected and condylar alterations were judged on panoramic radiographs. RESULTS: All ILAR categories of JIA were represented among the 266 referrals included in the study. The distribution of patients among categories resembled the pattern seen in epidemiological studies. Persistent oligoarthritis was the largest category with 36.5 % of the patients. Temporomandibular clinical signs (mild, moderate or severe) occurred in 57.7 % to 92.0 %, and subjective symptoms (mild or severe) in 32.0 % to 76.0 % of the patients in all categories. Patients in the juvenile psoriatic arthritis category had the largest number of orofacial signs and symptoms, and patients in the persistent oligoarthritis category had the fewest signs and symptoms. There were significant associations between clinical signs as well as subjective symptoms and overall disease activity. Half of all the patients had undergone panoramic examinations and 37.9 % of those were judged to have condylar alterations after a mean of 2.9 years after onset. No associations between radiological findings and variables, such as signs, symptoms or disease activity, were found. CONCLUSIONS: Temporomandibular signs and symptoms can be expected to a varying degree, including severe cases, in all JIA categories. Clinical and subjective orofacial involvement appears to be related to disease activity but not to condylar lesions.
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| 2. |
- Cedströmer, Anna-Lena, 1974, et al.
(författare)
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Condylar alterations and facial growth in children with juvenile idiopathic arthritis
- 2020
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Ingår i: Journal of Orofacial Orthopedics-Fortschritte Der Kieferorthopadie. - : Springer Science and Business Media LLC. - 1434-5293 .- 1615-6714. ; 81, s. 163-171
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The aim of this retrospective study was to evaluate facial growth in children with juvenile idiopathic arthritis (JIA) by means of lateral head cephalometric radiographs and relate the findings to temporomandibular joint (TMJ) condylar changes on panoramic radiographs. Methods Radiographic and medical records were evaluated in 65 children with JIA. Cephalometric and panoramic analyses were performed for the impact of condylar changes on facial growth. We compared children with condylar alterations, minor or major, with those without condylar alterations. Results Based on panoramic radiographs, no condylar alterations were seen in 27 of the 65 children and condylar alterations were seen in 38 children (i.e., 23 had minor and 15 major condylar alterations). The cephalometric analyses of the children with condylar changes showed significant growth disturbances with a more retrognathic mandible (SNB; p& x202f;= 0.03), retruded chin position (SNPog; p& x202f;= 0.02), larger mandibular angulation (ML/NSL; p& x202f;= 0.009) and maxillary angulation (NL/NSL; p& x202f;= 0.03) compared with children without condylar alterations. Children with minor condylar alterations had a significantly more retruded chin position (SNPog) than those with no condylar changes (p& x202f;= 0.04). Conclusions Condylar changes in the TMJ, judged on panoramic radiography, in children with JIA, have impact on craniofacial growth. Even minor alterations seem to have an impact.
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| 3. |
- Cedströmer, Anna-Lena, 1974
(författare)
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Juvenile idiopathic arthritis - manifestations in the jaws
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Juvenile idiopathic arthritis (JIA) is an inflammatory joint disease in children that can involve the temporomandibular joint (TMJ), consequently affect craniofacial growth, jaw function creating discomfort and pain. It is possible that the TMJ is one of the most frequently involved joints in JIA. Earlier studies have often comprised a limited number of patients and different classification criteria have been used. The introduction of new medical therapies might have influenced the prognosis for JIA in the jaw system. The overall aim was to investigate how JIA manifests in the jaws by evaluating symptoms from the orofacial region in adults once diagnosed with JIA. Also investigate clinical, subjective and radiological involvement of the TMJ on panoramic radiographs of children with JIA. Facial growth as judged on cephalometric radiographs was also evaluated. All the findings were related to medical treatment and disease activity over time. We found that adult patients with JIA report more pain and dysfunction in the orofacial region compared with healthy controls. Our study shows associations between orofacial signs, symptoms and overall disease activity in children with JIA. TMJ condylar alterations on panoramic radiographs are fairly common and active disease appears to increase the risk of alterations despite medication. Children with JIA seems to have a changed growth pattern compared with a healthy reference group and patients with condylar alterations have more retrognathia and posterior rotaded mandibles. An early TMJ diagnosis in children with JIA is important in order to prevent a negative effect on the TMJs. There is a lack of consensus on when and how to treat JIA in terms of the TMJ. Longer follow-up studies and further prospective studies with the emphasis on the progress of TMJ arthritis and the influence on facial growth are necessary.
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| 4. |
- Cedströmer, Anna-Lena, 1974, et al.
(författare)
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Temporomandibular condylar alterations in juvenile idiopathic arthritis most common in longitudinally severe disease despite medical treatment
- 2014
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Juvenile idiopathic arthritis (JIA) is an autoimmune, heterogeneous disease and the temporomandibular joint (TMJ) can be affected, with consequences for mandibular growth and function. The aim of this study was to evaluate the importance of longitudinal medical treatment and the burden of disease activity on the development of temporomandibular condylar alterations as judged on panoramic radiographs. Methods: The study was a retrospective evaluation of dental and medical records in consecutive JIA patients referred to three specialist dental clinics in Sweden during an eight-year period. Data on the total pharmacological treatment and disease activity were evaluated longitudinally from disease onset to the time of the panoramic examination, during a median observation period of 2.5 years. The radiographs were analysed in terms of structural and shape alterations in the condyles and judged dichotomously. Results: Panoramic examinations were analysed in 158 patients from 266 referrals diagnosed with JIA. Condylar alterations (shape or structural) were seen in 68 patients (43%). Patients with condylar alterations were more extensively treated over time compared with those without condylar alterations. Powerful disease activity and/or potent medication at any time during the course of the disease implied an increased risk of alterations. Conclusions: Patients with JIA who require more intensive medication over time run the greatest risk of condylar alterations. As yet, current medical programmes have not been specified for the TMJ and more knowledge in this area is needed.
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