Arthritis of the Temporomandibular Joints in Children with Juvenile Idiopathic Arthritis - Early Diagnosis and Treatment

The diagnosis of temporomandibular joint arthritis remains a challenge especially at an early stage of the disease before structural changes such as growth disturbances have already occurred. Pain is an unreliable and very unspecific symptom. A restricted movement with decreased mouth opening capacity is very common, but the interpretation is difficult because of the large range of normal values. Swelling or joint effusion are uncommon findings, and unfortunately also ultrasound is not able to reliably detect early temporomandibular arthritis. Therefore, magnetic resonance imaging remains the only method recommendable for an early diagnosis. The choice of treatment is based on the general arthritis activity of an individual patient: if only few joints are involved, intra-articular steroid injections are a quick and effective option. Children with more joints involved will benefit from systemic immunosuppressive drugs such as methotrexate. Based on more recent findings repeated steroid injections should be avoided.