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Differentiating arthritic from myofascial pain in children with juvenile idiopathic arthritis: preliminary report
Shelly Abramowicz1, Susan Kim, Harlyn K Susarla
1Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA, USA. shelly.abramowicz@childrens.harvard.edu
Insights
Juvenile idiopathic arthritis (JIA) in children can cause temporomandibular joint (TMJ) inflammation or myofascial pain (MPD), often overlapping. Differentiating these jaw conditions is crucial for effective JIA management.
Area of Science:
- Pediatric Rheumatology
- Craniofacial Pain Syndromes
- Temporomandibular Joint Disorders
Background:
- Juvenile idiopathic arthritis (JIA) can manifest with temporomandibular joint (TMJ) involvement.
- Differentiating TMJ inflammation from myofascial pain (MPD) in pediatric JIA patients is clinically challenging.
- Accurate diagnosis is essential for appropriate management of jaw-related symptoms in JIA.
Purpose of the Study:
- To distinguish between TMJ inflammation and MPD in children diagnosed with JIA.
- To analyze the clinical and radiographic features associated with each diagnosis.
- To understand the diagnostic overlap between TMJ arthritis and MPD in this population.
Main Methods:
- Retrospective review of medical records and imaging for pediatric JIA patients (≤16 years) with jaw symptoms.
- Classification based on clinical and radiographic evidence of TMJ inflammation versus muscle pain.
- Defined criteria for TMJ arthritis, MPD, and co-existing conditions.
Main Results:
- 61 JIA patients (mean age 12.7 years) were analyzed.
- Limited mouth opening and malocclusion were common clinical findings.
- 21 patients (34.4%) had TMJ arthritis, 21 (34.4%) had MPD, and 11 (18%) had both.
Conclusions:
- A significant overlap exists between TMJ arthritis and MPD diagnoses in children with JIA.
- These findings highlight the complexity of diagnosing jaw conditions in pediatric rheumatology.
- Improved diagnostic differentiation is necessary for optimizing patient care and treatment strategies.
Purpose:
To differentiate between temporomandibular joint (TMJ) inflammation and myofascial pain (MPD) in children with juvenile idiopathic arthritis (JIA).
Patients And Methods:
We performed a retrospective study of children with JIA evaluated at Boston Children's Hospital, Boston, Massachusetts. Patients, aged 16 years or younger at the time of diagnosis, were included if they had confirmed JIA with jaw signs or symptoms. Medical records and imaging studies were reviewed to document demographic, clinical, and radiographic findings. Patients with clinical evidence (joint pain/tenderness, asymmetry, limited motion) and radiographic evidence (condylar asymmetry, flattening, accentuated antegonial notch) of TMJ inflammation but without muscle pain were diagnosed with arthritis. Those with only muscle tenderness and/or limited jaw motion were diagnosed with MPD. Patients with TMJ inflammation and muscle pain/tenderness were considered to have co-existing arthritis and MPD. Outcome variables were the presence of TMJ arthritis and/or MPD. Descriptive statistics were computed.
Results:
There were 61 patients (44 girls) with a mean age of 12.7 years (range, 3 to 16 years) who met the inclusion criteria. The most common clinical findings were limited mouth opening (n = 24), malocclusion/asymmetry (n = 23), and/or tenderness to palpation (n = 18). Twenty-one patients had multiple signs and symptoms. Panoramic radiographs showed condylar abnormalities in 32 patients. Overall, 21 patients (34.4%) were diagnosed with active TMJ arthritis, 21 (34.4%) with MPD, and 11 (18%) with both arthritis and MPD. Of the patients, 8 (13.1%) were in remission.
Conclusions:
The results of this study indicate that in patients with JIA and jaw signs/symptoms, there is an overlap in diagnoses between arthritis and MPD. This has considerable implications for patient management.
