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Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary consensus-based recommendations

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  • Peter Stoustrup
  • Cory M Resnick, Division of Genetics, Boston Children's Hospital, Boston, MA, USA; Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
  • ,
  • Shelly Abramowicz, Emory University
  • ,
  • Thomas K Pedersen
  • Ambra Michelotti, University of Naples Federico II
  • ,
  • Annelise Küseler
  • Bernd Koos, University of Tübingen
  • ,
  • Carlalberta Verna
  • Ellen B Nordal, University Hospital of Northern Sealand
  • ,
  • Eric J Granquist, University of Pennsylvania
  • ,
  • Josefine Mareile Halbig, UiT The Arctic University of Norway
  • ,
  • Kasper D Kristensen
  • Leonard B Kaban, Harvard University
  • ,
  • Linda Z Arvidsson, University of Oslo
  • ,
  • Lynn Spiegel, University of Toronto
  • ,
  • Matthew L Stoll, University of Alabama at Birmingham
  • ,
  • Melissa A Lerman, University of Pennsylvania
  • ,
  • Mia Glerup
  • Patrizia Defabianis, University of Turin
  • ,
  • Paula Frid, University Hospital of North Norway
  • ,
  • Per Alstergren, Malmö University
  • ,
  • Randy Q Cron, University of Alabama at Birmingham
  • ,
  • Sarah Ringold, Seattle Children's Hospital
  • ,
  • Sven Erik Nørholt
  • Timo Peltomaki, Tampere University
  • ,
  • Tore A Larheim, University of Oslo
  • ,
  • Troels Herlin
  • Zachary S Peacock, Harvard University
  • ,
  • Christian J Kellenberger, University of Zurich
  • ,
  • Marinka Twilt, Alberta Children's Hospital, University of Calgary

OBJECTIVES: Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, dysfunction and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management.

OBJECTIVES: 1) To develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA. 2) To create a future research agenda related to management of TMJ arthritis in children with JIA.

METHODS: The recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during two consensus-meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: Pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study.

RESULTS: Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to: diagnosis (n=4), treatment of TMJ arthritis (active TMJ inflammation) (n=2), treatment of TMJ dysfunction and symptoms (n=3), treatment of arthritis-related dentofacial deformity (n=2), and other related aspects to JIA (n=1). Additionally, a future interdisciplinary research agenda was developed.

CONCLUSIONS: These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA. This article is protected by copyright. All rights reserved.

Original languageEnglish
Article number42338
JournalArthritis & Rheumatology
Pages (from-to)4-14
Number of pages11
Publication statusPublished - 1 Jan 2023

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This article is protected by copyright. All rights reserved.

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