Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

Peter Stoustrup¹, Cory M Resnick², Shelly Abramowicz³, Thomas K Pedersen⁴, Ambra Michelotti⁵, Annelise Küseler⁴, Bernd Koos⁶, Carlalberta Verna⁷, Ellen B Nordal⁸, Eric J Granquist⁹, Josefine Mareile Halbig¹⁰, Kasper D Kristensen¹, Leonard B Kaban¹¹, Linda Z Arvidsson¹², Lynn Spiegel¹³, Matthew L Stoll¹⁴, Melissa A Lerman¹⁵, Mia Glerup¹⁶, Patrizia Defabianis¹⁷, Paula Frid¹⁸, Per Alstergren¹⁹, Randy Q Cron¹⁴, Sarah Ringold²⁰, Sven Erik Nørholt⁴, Timo Peltomaki²¹, Tore A Larheim¹², Troels Herlin¹⁶, Zachary S Peacock¹¹, Christian J Kellenberger²², Marinka Twilt²³; Temporomandibular Joint Juvenile Arthritis Working Group

Affiliations

¹ Section of Orthodontics, Aarhus University, Aarhus, Denmark.
² Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
³ Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
⁴ Section of Orthodontics and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁵ University of Naples Federico II, Naples, Italy.
⁶ Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.
⁷ Department of Pediatric Oral Health and Orthodontics, UZB University Center for Dentistry Basel, University of Basel, Basel, Switzerland.
⁸ Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁹ Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia.
¹⁰ The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
¹¹ Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts.
¹² Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
¹³ The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁴ University of Alabama at Birmingham.
¹⁵ Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁶ Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹⁷ Section of Paediatric Dentistry, Dental School, University of Turin, Turin, Italy.
¹⁸ Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
¹⁹ Faculty of Odontology, Orofacial Pain Unit, Malmö University, Malmö, Sweden.
²⁰ Seattle Children's Hospital, Seattle, Washington.
²¹ Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
²² Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
²³ Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.

PMID: 36041065
PMCID: PMC10100353
DOI: 10.1002/art.42338

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

Peter Stoustrup et al. Arthritis Rheumatol. 2023 Jan.

. 2023 Jan;75(1):4-14.

doi: 10.1002/art.42338. Epub 2022 Nov 25.

Authors

Affiliations

¹ Section of Orthodontics, Aarhus University, Aarhus, Denmark.
² Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
³ Division of Oral and Maxillofacial Surgery, Departments of Surgery and Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
⁴ Section of Orthodontics and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁵ University of Naples Federico II, Naples, Italy.
⁶ Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany.
⁷ Department of Pediatric Oral Health and Orthodontics, UZB University Center for Dentistry Basel, University of Basel, Basel, Switzerland.
⁸ Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
⁹ Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia.
¹⁰ The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
¹¹ Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, Massachusetts.
¹² Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.
¹³ The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
¹⁴ University of Alabama at Birmingham.
¹⁵ Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
¹⁶ Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
¹⁷ Section of Paediatric Dentistry, Dental School, University of Turin, Turin, Italy.
¹⁸ Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
¹⁹ Faculty of Odontology, Orofacial Pain Unit, Malmö University, Malmö, Sweden.
²⁰ Seattle Children's Hospital, Seattle, Washington.
²¹ Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
²² Department of Diagnostic Imaging, University Children's Hospital Zürich, Zürich, Switzerland.
²³ Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.

PMID: 36041065
PMCID: PMC10100353
DOI: 10.1002/art.42338

Abstract

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.

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Figures

**Figure 1**
Outline of the consensus process for the development of interdisciplinary recommendations for the management of temporomandibular joint arthritis in children with juvenile idiopathic arthritis.

See this image and copyright information in PMC

Comment in

New guide calls for interdisciplinary approach to TMJ arthritis symptoms.
McHugh J. McHugh J. Nat Rev Rheumatol. 2022 Nov;18(11):612. doi: 10.1038/s41584-022-00857-6. Nat Rev Rheumatol. 2022. PMID: 36198830 No abstract available.

References

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Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

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Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

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