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Temporomandibular Joint Arthritis in Juvenile Dermatomyositis and Pediatric Mixed Connective Tissue disease

Peter Weiser, Stephen Johnson, Robert Lowe, Randy Cron.

Inflammation of the temporomandibular joint (TMJ) is a frequent finding in juvenile idiopathic arthritis and can lead to facial deformity. Our retrospective cohort review aimed to address presence of similar TMJ arthritis in myositis associated connective tissue disorders.

Electronic health records of patients at the Children’s of Alabama, Birmingham, AL, USA with TMJ arthritis on contrasted MRI examination and diagnosed with juvenile dermatomyositis (JDM) or mixed connective tissue disease (MCTD) between January 2010 to March 2012 were reviewed for subjective and objective findings of TMJ involvement.During that period, four patients with JDM and three patients with MCTD were found to have imaging proof of TMJ arthritis. Two of the four JDM patients and two of the three MCTD patients did not report pain at rest nor with mastication and only one of the JDM patients with pain had jaw deviation on mouth opening. Peripheral arthritis was present in the two JDM patients with TMJ pain and in all MCTD patients. The two JDM patients with no TMJ pain nor deviation nor peripheral joint involvement had even low disease activity score as per physician global assessment score.

Children with myositis associated connective tissue disease can also have concurrent TMJ arthritis and as in JIA it can have a silent progression. Peripheral arthritis seems to be associated with TMJ arthritis, but larger studies are needed for incidence, prevalence and possible progression evaluation and for indications of therapy. We suggest that evaluation of the TMJ should be part of the diagnostic work-up for pediatric arthritis-associated autoimmune connective tissue diseases with or without active peripheral arthritis.

Key words: Temporomandibular Joint, Juvenile dermatomyositis, MCTD, arthritis

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