Current issue
Archive
Online first
About the Journal
Editorial Office
Editorial Board
Publisher
Editorial Policies
Ethical standards and procedures
Abstracting and indexing
Reviewers
Honorary Reviewers
Subscription
Contact
Most read articles
Instructions for authors
Article processing charge (APC)
Books and Events
Books
Events
REVIEW PAPER
Facial asymmetry and mandibular hypomobility as early indicators of temporomandibular joint involvement in juvenile idiopathic arthritis
1
Department of Dental Traumatology, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, Poznan, Poland
Submission date: 2025-07-15
Final revision date: 2025-09-23
Acceptance date: 2025-11-18
Publication date: 2026-04-30
Corresponding author
Reumatologia 2026;64(2):151-158
KEYWORDS
TOPICS
ABSTRACT
Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is often underrecognized. A comprehensive review highlights a frequent discrepancy between clinical symptoms and radiologic findings in TMJ arthritis among JIA patients. Key clinical indicators include facial asymmetry, limited mouth opening, and mandibular deviation. We present a case of a 9-year-old girl with JIA and no reported TMJ symptoms. Clinical assessment revealed facial asymmetry, mandibular deviation, and restricted mandibular mobility. Cone beam computed tomography showed the presence of unilateral condylar flattening and shortening of the mandibular ramus. This case underscores the importance of recognizing facial asymmetry and mandibular hypomobility as potential early indicators of TMJ arthritis in children with JIA, even in the absence of any symptoms or signs. Early detection through attention to subtle morphofunctional signs is imperative for improving patient outcomes in asymptomatic JIA cases.
REFERENCES (37)
1.
Martini G, Bacciliero U, Tregnaghi A, et al. Isolated temporomandibular synovitis as unique presentation of juvenile idiopathic arthritis. J Rheumatol 2001; 28: 1689–1692.
2.
Scolozzi P, Bosson G, Jaques B. Severe isolated temporomandibular joint involvement in juvenile idiopathic arthritis. J Oral Maxillofac Surg 2005; 63: 1368–1371, DOI: 10.1016/j.joms.2005. 05.300.
3.
Cedströmer A, Andlin-Sobocki A, Berntson L, et al. Temporomandibular signs, symptoms, joint alterations and disease activity in juvenile idiopathic arthritis – an observational study. Pediatr Rheumatol Online J 2013; 11: 37, DOI: 10.1186/1546-0096-11-37.
4.
Argyropoulou MI, Margariti PN, Karali A, et al. Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs. Eur Radiol 2009; 19: 693–700, DOI: 10.1007/s00330-008-1196-2.
5.
Collin M, Resnick C, LeBlanc JG, et al. TMJ involvement in children with JIA: a systematic review. J Oral Rehabil 2021; 48: 388–400, DOI: 10.1111/joor.13060.
6.
Arabshahi B, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis: the forgotten joint. Curr Opin Rheumatol 2006; 18: 490–495, DOI: 10.1097/01.bor.0000240360.24465.4c.
7.
Pedersen TK, Jensen JJ, Melsen B, Herlin T. Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. J Rheumatol 2001; 28: 2109–2115.
8.
Pawlaczyk-Kamienska T, Pawlaczyk-Wróblewska E, Borysewicz-Lewicka M. Early diagnosis of temporomandibular joint arthritis in children with juvenile idiopathic arthritis: a systematic review. Eur J Paediatr Dent 2020; 21: 219–226, DOI: 10.23804/ejpd.2020.21.03.12.
9.
Weiss PF, Arabshahi B, Johnson A, et al. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Arthritis Rheum 2008; 58: 1189–1196, DOI: 10.1002/art.23401.
10.
Twilt M, Schulten AJM, Verschure F, et al. Long-term follow-up of temporomandibular joint involvement in juvenile idiopathic arthritis. Arthritis Rheum 2008; 59: 546–552, DOI: 10.1002/art.23532.
11.
Huntjens E, Kiss G, Wouters C, et al. Condylar asymmetry in children with juvenile idiopathic arthritis assessed by cone-beam computed tomography. Eur J Orthod 2008; 30: 545–551, DOI: 10.1093/ejo/cjn056.
12.
Stoll ML, Kau CH, Waite PD, Cron RQ. Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what? Pediatr Rheumatol 2018; 16: 32, DOI: 10.1186/s12969-018-0244-y.
13.
Savioli C, Silva CA, Ching LH, et al. Dental and facial characteristics of patients with juvenile idiopathic arthritis. Rev Hosp Clin Fac Med Sao Paulo 2004; 59: 93–98, DOI: S0041-87812004000300001.
14.
Leksell E, Ernberg M, Magnusson B, Hedenberg-Magnusson B. Intraoral condition in children with juvenile idiopathic arthritis compared to controls. Int J Paediatr Dent 2008; 18: 423–433, DOI: 10.1111/j.1365-263X.2008.00931.x.
15.
Pawlaczyk-Kamieńska T, Kulczyk T, Pawlaczyk-Wróblewska E, et al. Limited Mandibular Movements as a Consequence of TMJ Involvement in JIA. J Clin Med 2020; 9: 2576, DOI: 10.3390/jcm9082576.
16.
Hu Y, Verdonck A, Carels C, et al. Comparison of clinical and radiographic findings for TMJ involvement in JIA. J Dent Res 2009; 88: 294–299, DOI: 10.1177/0022034508331110.
17.
Twilt M, Mobers SM, Arends LR, et al. Temporomandibular involvement in juvenile idiopathic arthritis. J Rheumatol 2004; 31: 1418–1422.
18.
Stoustrup P, Twilt M, Spiegel L, et al. Clinical Orofacial Examination in Juvenile Idiopathic Arthritis: International Consensus-based Recommendations for Monitoring Patients in Clinical Practice and Research Studies. J Rheumatol 2017; 44: 326–333, DOI: 10.3899/jrheum.160796.
19.
Benlidayi IC, Gupta L. CAse-BAsed REview sTandards (CABARET): Considerations for Authors, Reviewers, and Editors. J Korean Med Sci 2024; 39: e225, DOI: 10.3346/jkms.2024.39.e225. .
20.
Billiau AD, Hu Y, Verdonck A, et al. Temporomandibular joint arthritis in juvenile idiopathic arthritis: prevalence, clinical and radiological signs, and relation to dentofacial morphology. J Rheumatol 2007; 34: 1925–1933.
21.
Koos B, Twilt M, Kyank U, et al. Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis. J Rheumatol 2014; 41: 1871–1877, DOI: 10.3899/jrheum.131337.
22.
Engstrom AL, Wanman A, Johansson A, et al. Juvenile arthritis and development of symptoms of temporomandibular disorders: a 15-year prospective cohort study. J Orofac Pain 2007; 21: 120–126.
23.
Arvidsson LZ, Flatø B, Larheim TA. Radiographic TMJ abnormalities in patients with juvenile idiopathic arthritis followed for 27 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 114–123, DOI: 10.1016/j.tripleo.2009.03.012.
24.
Keller H, Müller LM, Markic G, et al. Is early TMJ involvement in children with juvenile idiopathic arthritis clinically detectable? Pediatr Rheumatol Online J 2015; 13: 56, DOI: 10.1186/s12969-015-0056-2.
25.
Stoustrup P, Pedersen TK, Nørholt SE, et al. Interdisciplinary management of dentofacial deformity in juvenile idiopathic arthritis. Oral Maxillofac Surg Clin North Am 2020; 32: 117–134, DOI: 10.1016/j.coms.2019.09.002.
26.
Küseler A, Pedersen TK, Gelineck J, et al. A 2-year follow-up study of enhanced MRI and clinical examination of the TMJ in children with juvenile idiopathic arthritis. J Rheumatol 2005; 32: 162–169.
27.
Jank S, Hasse S, Strobl H, et al. Sonographic investigation of the TMJ in patients with juvenile idiopathic arthritis: a pilot study. Arthritis Rheum 2007; 57: 213–216.
28.
Mohammed Y, Saeed O, Zaghloul N, et al. Juvenile idiopathic arthritis and the temporomandibular joint. Alexandria Journal of Medicine 2012; 48: 123–129, DOI: 10.1016/j.ajme.2011.11.004.
29.
Collin M, Christidis N, Hagelberg S, et al. Temporomandibular involvement in children and adolescents with juvenile idiopathic arthritis: a 2-year prospective cohort study. Sci Rep 2024; 14: 5512, DOI: 10.1038/s41598-024-56174-3.
30.
Müller L, Kellenberger CJ, Cannizzaro E, et al. Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology 2009; 48: 680–685. DOI: 10.1093/rheumatology/kep068. .
31.
Hintze H, Wiese M, Wenzel A. Cone beam CT and conventional tomography for the detection of morphological temporomandibular joint changes. Dentomaxillofac Radiol 2007; 36: 192–197, DOI: 10.1259/dmfr/25523853.
32.
Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008; 37: 63–71, DOI: 10.1259/dmfr/16932758. .
33.
Assaf AT, Kahl-Nieke B, Feddersen J, Habermann CR. Is high-resolution ultrasonography suitable for the detection of temporomandibular joint involvement in children with juvenile idiopathic arthritis? Dentomaxillofac Radiol 2013; 42: 20110379, DOI: 10.1259/dmfr.20110379.
34.
Tonni I, Borghesi A, Tonesi S, et al. An ultrasound protocol for temporomandibular joint in juvenile idiopathic arthritis: a pilot study. Dentomaxillofac Radiol 2021; 50: 20200399, DOI: 10.1259/dmfr.20200399.
35.
Costello A, Twilt M, Lerman MA; CARRA Registry Investigators. Provider assessment of the temporomandibular joint in Juvenile idiopathic arthritis: a retrospective analysis from the CARRA database. Pediatr Rheumatol Online J 2024; 22: 41, DOI: 10.1186/s12969-024-00968-2. .
36.
Farkas LG. Anthropometry of the head and face. 2nd ed. Raven Press, New York 1994.
37.
Müller L, van Waes H, Langerweger C, et al. Maximal mouth opening capacity: percentiles for healthy children 4–17 years of age. Pediatr Rheumatol Online J 2013; 11: 17, DOI: 10.1186/ 1546-0096-11-17.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
