Paula Frid1, Ellen Nordal2, Francesca Bovis3, Gabriella Giancane3, Tore A Larheim4, Marite Rygg5, Denise Pires Marafon3, Donato De Angelis3, Elena Palmisani3, Kevin J Murray6, Sheila Oliveira7, Gabriele Simonini8, Fabrizia Corona9, Joyce Davidson10, Helen Foster11, Michel H Steenks12, Berit Flato13, Francesco Zulian14, Eileen Baildam15, Rotraud K Saurenmann16, Pekka Lahdenne17, Angelo Ravelli18, Alberto Martini18, Angela Pistorio19, Nicolino Ruperto3. 1. University Hospital of North Norway, UiT The Arctic University of Norway, and Public Dental Competence Center of Northern Norway, Tromsø, Norway. 2. University Hospital of North Norway, and UiT The Arctic University of Norway, Tromsø, Norway. 3. Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy. 4. UiT The Arctic University of Norway, Tromsø, and University of Oslo, Oslo, Norway. 5. Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway. 6. Princess Margaret Hospital for Children, Perth, Australia. 7. Universidade Federal do Rio de Janeiro, and Instituto de Puericultura e Pediatria Martagao Gesteira, Rio de Janeiro, Brazil. 8. Azienda Ospedaliero-Universitaria Meyer, Florence, Italy. 9. Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 10. Royal Hospital for Sick Children, Glasgow, UK. 11. Newcastle University, Newcastle Hospitals NHS Foundation Trust, and Great North Children's Hospital, Newcastle Upon Tyne, UK. 12. University Medical Center Utrecht, Utrecht, The Netherlands. 13. Oslo University Hospital and University of Oslo, Oslo, Norway. 14. Clinica Pediatrica, Padova, Italy. 15. Alder Hey Children's NHS Foundation Trust, Liverpool, UK. 16. Kantonsspital Winterthur, Winterthur, Switzerland. 17. Children's Hospital and Helsinki University Central Hospital, Helsinki, Finland. 18. Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy. 19. Istituto Giannina Gaslini, Genoa, Italy.
Abstract
OBJECTIVE: To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. METHODS: This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. RESULTS: Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. CONCLUSION: Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.
OBJECTIVE: To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. METHODS: This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. RESULTS: Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. CONCLUSION: Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.
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