Effects of systemic onset juvenile rheumatoid arthritis on facial morphology and temporomandibular joint form and function

Objective. Twenty-four patients with systemic onset juvenile rheumatoid arthritis (JRA) were evaluated to determine its effects on facial morphology and temporomandibular joint (TMJ) form and function. Methods. Patients were evaluated with medical and dental histories, facial photographs, intraoral examination, TMJ examination, lateral tomograms or panoramic radiographs, cephalograms, and impressions for study models. The craniomandibular index (CMI) was used to quantitate mandibular movement, tenderness, and TMJ noise. Symptoms were measured by symptom severity index (SSI). CMI data from the patients with JRA were compared to a group of 24 children without JRA with similar mean age and sex distribution. Results. Our study indicates the facial morphology of patients with systemic onset JRA is similar to that of healthy children except for a mild convex facial profile and backward rotation of the mandible. Changes in facial form were associated with radiographic condylar abnormalities. CMI scores and SSI scores of systemic onset patients were significantly greater than controls, and radiographic condylar changes were noted in 29.2% of the patients with systemic onset JRA. Conclusion. Our study suggests that systemic onset JRA significantly affects TMJ form and function. Facial form was only affected in the few patients with significant radiographic condylar changes.