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Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis in children. Juvenile idiopathic arthritis is a term used to describe a heterogeneous group of autoimmune diseases leading to synovial-related inflammations of unknown etiology, which begins before the age of 16, affects at least one joint and persists for not less than 6 weeks.1-3 Juvenile idiopathic arthritis could affect any of the axial or peripheral body joints and is classified according to the International League of Associations for Rheumatology (ILAR) into 7 subtypes based on the pattern of arthritis development during the initial 6-month interval, which include systemic-onset, oligoarticular, rheumatoid factor (RF)-positive polyarthritis, RF-negative polyarthritis, enthesitis-related, psoriatic, and undifferentiated arthritis.2 The diagnosis of JIA is a diagnosis of exclusion, which mainly depends on a clinical assessment with little to no role of laboratory tests or supplementary imaging studies. However, the laboratory and imaging studies would be helpful in subtype classification.3
Children diagnosed with JIA often develop inflammation of the temporomandibular joint (TMJ). Temporomandibular joint is a joint that connects the skull with the lower jaw. An articular disc made up of fibrous connective tissue divides the joint space into upper and lower compartments. The movements that take place in this joint is quite complex, rotary or hinge movement around a horizontal axis during mouth opening through the center of condylar heads bilaterally. And gliding or translatory movement of the mandible in the anteroposterior and/or mediolateral direction. Gliding or translator movement occur at the upper compartment while the lower compartment allows rotary or hinge movement.4 The prevalence of TMJ arthritis in children with JIA was reported to be up to 87%.5-11
Untreated TMJ arthritis in children can lead to mandibular growth limitation, which causes jaw asymmetry, malocclusion, and limited maximal incisal opening (MIO).11-13 Diagnosis of TMJ involvement in children with JIA remains difficult, thereby it would be beneficial to be able to identify children who are at high risk for TMJ involvement.10 Providers could refer and intervene earlier and would likely help prevent progression. Temporomandibular joint involvement may be present in all JIA subtypes and, occasionally, it is the only joint involved.11-14 Among local studies, clinical and laboratory manifestations of a total of 115 patients...