The Long-Term Clinical and Radiographic Evolution of Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: A Narrative Review and 15-Year Follow-Up Case Report

Abstract

Highlights What are the main findings? TMJ involvement progressed structurally despite systemic antirheumatic treatment, while multidisciplinary management achieved sustained clinical and functional improvement. Long-term follow-up demonstrated persistent structural TMJ changes, underscoring the potential long-term orofacial impact of JIA. What are the implications of the main findings? Clinical remission does not necessarily reflect structural stability of the TMJ in JIA. Longitudinal multidisciplinary surveillance of the TMJ and orofacial complex, including imaging, is warranted to detect clinically silent disease progression. Abstract Background/Objectives: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and may involve the temporomandibular joint (TMJ), sometimes with limited clinical manifestations. This report combines a narrative review of TMJ involvement in JIA with a 15-year follow-up of a patient with JIA-associated TMJ disease. The objectives were to summarize current evidence regarding the clinical assessment and management of TMJ involvement in JIA and to describe the relationship between long-term clinical and structural findings in an individual patient. Case Report: A 12-year-old girl with newly diagnosed oligoarticular JIA was referred by the pediatric rheumatologist to the Clinic of Orofacial Pain Management, National and Kapodistrian University of Athens. At referral, TMJ involvement was identified despite systemic antirheumatic treatment. The patient presented with orofacial pain, restricted mouth opening, mandibular deviation, multiple painful orofacial sites, maximum interincisal opening of 26 mm, reduced mandibular excursions, marked masticatory muscle tenderness, and an anterior open bite. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated bilateral active TMJ synovitis, early condylar erosions, and anterior disc displacement, with reduction on the right and without reduction on the left. Management comprised systemic antirheumatic therapy together with a structured physiotherapy program and a maxillary stabilization splint. Results: At one-year follow-up, maximum mouth opening had increased to 50 mm, with substantial improvement in mandibular function and symptoms. Fifteen years after the initial TMJ assessment, the patient remained pain-free with satisfactory mandibular function and a maximum mouth opening of 46 mm. Panoramic radiography at long-term follow-up demonstrated bilateral condylar abnormalities, including flattening, osteophyte formation, and intraosseous cystic changes. Because the initial and long-term assessments were performed using different imaging modalities, these findings cannot be directly compared to establish longitudinal structural progression. Conclusions: This case illustrates dissociation between favorable long-term clinical and functional status and substantial structural abnormalities identified at follow-up in a patient with JIA-associated TMJ involvement. It also highlights the limitations of relying on clinical symptoms and function alone to characterize TMJ structural status. The literature supports multidisciplinary management and individualized clinical and imaging assessment of TMJ involvement in JIA; however, prospective studies with standardized serial imaging are needed to better define the relationship between clinical outcomes and structural changes over time.