All ETDs from UAB

Advisory Committee Chair

Chung How Kau

Advisory Committee Members

Ejvis Lamani

Matthew Stoll

Randall Cron

Document Type

Thesis

Date of Award

2024

Degree Name by School

Master of Dentistry (MDent) School of Dentistry

Abstract

JIA, which stands for juvenile idiopathic arthritis, is a group of chronic inflammatory joint diseases that usually occur in children under the age of 16 and last for at least six weeks1–5. It is one of the most common chronic joint diseases in childhood1 and affects up to 150 out of every 100,000 children worldwide6. This condition has no identifiable cause and is different from adult rheumatoid arthritis. Unfortunately, JIA can have a significant negative impact on the lives of these young children, causing disability and impairing their daily activities. TMJ involvement is more common than previously believed in JIA patients, with approximately half of children7 with JIA experiencing issues with their "forgotten joint." The occurrence of TMJ involvement can range from 17% to 87% depending on JIA subtype5,7,8 diagnostic criteria, and ethnicity. Asymmetric cases can lead to facial deformities and malocclusion, making it difficult to receive adequate Orthodontic treatment due to lack of growth and dental occlusion. Bilateral involvement occurs in the majority of cases9,10. The onset of TMJ pathology varies from JIA onset11, and the exact cause is unknown. Objectives: A crucial aspect in identifying TMJ arthritis at an early stage is to provide appropriate training to Orthodontists for recognizing patients with indications of arthritis. It is important to closely monitor children whose JIA specifically involves or originates from the TMJ, to prevent any detrimental impact on the jaw joints or any alteration in bite. In the past few decades, the awareness of JIA and its treatment has substantially increased, resulting in a decline in severe growth disorders and malocclusions. Methods: Subjects for the study have been recruited from 2 centers in Birmingham Alabama, USA – The Division of Pediatric Rheumatology, Children’s Hospital (PRCH) and the Craniofacial Orthodontia Disorders Clinic, Department of Orthodontics, UAB (CODC). These patients were enrolled between July 2016 and December 2018. All subjects from 8-16 years were included. JIA patients had a clinical diagnosis from a Rheumatologist. This was a retrospective study conducted at University of Alabama at Birmingham. School of dentistry and Children’s of Alabama, Birmingham, USA. We identified 31 children with JIA who met International Classification of Diseases-9th edition codes associated with JIA, limited to patients evaluated by a pediatric rheumatologist. These patients attended the UAB Orthodontic Department for a comprehensive dental examination where cone-beam CT images were obtained as part of the clinical evaluation. Inclusion criteria were diagnosis of JIA according to the International League of Associations for Rheumatology (ILAR) criteria and completion of TMJ MRI. Only patients who had MRI and CBCT images with a TMJ field of view in their diagnostic records were included. All these patients also had the clinical examination done under the AARHUS examination protocol. Exclusion criteria were any alternative diagnosis besides JIA. 1) congenital syndrome; 2) craniofacial trauma; and 3) previous orthognathic surgery. All these patients had TMJ function measured from the Aarhus Clinical Orofacial Examination Protocol. Results: Results of the study indicate a limited correlation between clinical manifestations, as assessed through the AARHUS questionnaire, and radiographic signs detected by MRI and CBCT in individuals with Juvenile Idiopathic Arthritis (JIA). Specifically, only a fraction of the physical (6 out of 29), physical attributes (8 out of 27), perceived attributes (2 out of 25), and esthetic attributes (1 out of 8) demonstrated a co-relation with radiographic findings. These findings are not enough to indicate JIA. Conclusions: These findings suggest that JIA can often present as a silent disease, remaining undetected until radiographic signs become evident. While the AARHUS questionnaire offers valuable insights into patients' perceptions and functional limitations, it appears that certain radiographic signs on MRI and CBCT may not manifest in a manner that aligns with patients' self-reported experiences.

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