Diagnostic Approach and Management of TMJ Arthritis in JIA

Diagnostic Approach for TMJ Involvement in JIA

The American College of Rheumatology suggests that patients with JIA presenting with TMJ tenderness on examination may indicate TMJ arthritis, which can be confirmed with imaging studies 3
X-ray findings showing reduced anterior translation of the mandibular condyle compared to the left suggest possible TMJ dysfunction, and further imaging with contrast-enhanced MRI is recommended 1
Contrast-enhanced MRI is currently the best method to detect active TMJ arthritis with a high level of evidence (LoE 2), and can visualize both soft tissue inflammation and osteochondral changes 1, 2

The American College of Rheumatology recommends that optimal systemic treatment should be considered as the primary approach for active TMJ arthritis in JIA patients 4, 5
For skeletally immature patients, intraarticular glucocorticoid injections are not recommended as first-line treatment due to potential risks of growth suppression and intraarticular calcifications 3, 4
For skeletally mature patients, intraarticular glucocorticoid injections may be considered if there is inadequate response to systemic therapy 4, 5

Optimal management of TMJ arthritis requires an interdisciplinary approach involving rheumatologists, oral/maxillofacial specialists, and other healthcare providers 2, 6
Referral to an oral/maxillofacial surgeon or a multidisciplinary TMJ clinic should be considered if MRI confirms active inflammation or significant structural changes, according to the American College of Rheumatology 6
Physical therapy and occlusal splints may be beneficial for managing TMJ dysfunction and symptoms, as suggested by the American College of Rheumatology 7