TMJ Involvement in Juvenile Idiopathic Arthritis: Challenges and Clinical Imperatives
Written by Dr. Agatha Bis
Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatologic condition in children. Among its many complications, temporomandibular joint (TMJ) involvement remains one of the most underdiagnosed and undertreated. Often referred to as the “forgotten joint,” the TMJ plays a crucial role in mastication, speech, and craniofacial development.
Despite the high prevalence of TMJ arthritis in JIA, detection is often delayed due to its silent nature and the low sensitivity of clinical examination. This blog reviews current evidence, diagnostic challenges, and clinical strategies for dental professionals.
Epidemiology and Risk
Reported prevalence of TMJ involvement in JIA ranges widely from 10 percent to 96 percent. This variation reflects differences in diagnostic methods rather than true variability. Clinical examinations underestimate prevalence, while contrast-enhanced MRI reveals rates above 50 percent across most subtypes.
Patients with polyarticular disease courses, extended oligoarticular JIA, and RF-negative polyarticular JIA present the highest risk. Conversely, enthesitis-related arthritis shows the lowest risk, often linked with protective HLA-B27 markers.
Pathophysiology and Growth Impact
The mandibular condyle is particularly vulnerable because the growth center lies adjacent to the synovial space. Inflammatory cascades disrupt chondrocyte function and ossification, leading to impaired growth, micrognathia, and facial asymmetry. In bilateral cases, retrognathia and open bite are common. Unilateral cases often present with chin deviation.
Diagnostic Limitations
Clinical signs such as pain, crepitation, and limited opening have high specificity but poor sensitivity.
Ultrasound is limited by bony structures and provides poor visualization.
Conventional radiography detects only late-stage damage.
CBCT and CT provide high-resolution imaging of bony changes but fail to identify early soft tissue inflammation.
CE-MRI remains the gold standard for detecting active synovitis and early disease progression.
Management Strategies
Modern guidelines emphasize early and aggressive systemic therapy.
NSAIDs may be used short term but are not disease-modifying.
Methotrexate remains first-line csDMARD.
Biologic DMARDs such as TNF inhibitors, IL-1 inhibitors, and IL-6 inhibitors have shown strong evidence in reducing TMJ inflammation and preserving condylar morphology.
Intra-articular corticosteroid injections are discouraged in skeletally immature patients due to growth suppression risks.
Adjunctive care includes occlusal splints to support growth, physical therapy for functional rehabilitation, and surgical interventions for refractory or end-stage cases.
Clinical Consequences of Delay
Untreated TMJ arthritis contributes to significant dentofacial deformities, malocclusion, obstructive sleep apnea, and psychosocial distress. It also acts as a disease multiplier, amplifying overall disability scores in JIA patients.
Dentists have a vital role in identifying and managing TMJ involvement in pediatric patients. Stay ahead in clinical knowledge. Join our professional community through the Study Club, take TMJ Essentials Level 1, or connect with Dr. Agatha Bis for mentoring. Email us at info@tmjwhispereracademy.com for more details.