Effects of Biologics on Temporomandibular Joint Inflammation in Juvenile Idiopathic Arthritis.

Abstract

This prospective study investigates the efficacy of biologics in combination with methotrexate (MTX) or leflunomide (LEF) on juvenile idiopathic arthritis (JIA)-related temporomandibular joint (TMJ) arthritis measured by magnetic resonance imaging (MRI)-based inflammation score and deformity score. A prospective, single-center observational cohort study of 18 consecutive patients was performed between September 2018 and April 2023. Inclusion criteria were (1) diagnosis of JIA, (2) MRI-verified TMJ arthritis leading to treatment with tumor necrosis factor inhibitor (TNFi), (3) MRI at 6 months and 24 months after treatment initiation, and (4) clinical follow-up together with an MRI by a pediatric rheumatologist and an orthodontist. We included 18 patients (89% female). At the time of the first MRI, median age was 13.2 years (IQR 9.9-17.4), median disease duration was 7.8 years (IQR 3.4-11.1), and 4 received MTX or LEF. During the observation period, significant improvements were observed in TMJ movement pain (<i>P</i> = 0.01), morning stiffness (<i>P</i> = 0.004), opening capacity (<i>P</i> = 0.03), and maximal incisal opening (<i>P</i> = 0.006). The inflammation score decreased significantly from a median of 2 (IQR 1-3) at baseline to a median of 1 (IQR 0-2) at 24 months (<i>P</i> = 0.009). In 17 of 36 TMJs (47%), the deformity score improved or remained stable and no significant increase in the median score was observed. This is the first prospective, observational study with evidence to support that the orofacial signs, symptoms, and MRI-derived inflammation score in TMJ arthritis can be reduced by treatment with TNFi.