TNFi eases TMJ inflammation in patients with JIA

Treatment with tumour necrosis factor inhibitor (TNFi) can reduce the orofacial signs, symptoms, and MRI-derived inflammation score in patients with juvenile idiopathic arthritis (JIA)-related temporomandibular joint (TMJ) arthritis, a study has shown.

Eighteen consecutive patients (89 percent female) were included in this prospective, single-centre observational cohort study, with a median age of 13.2 years and median disease duration of 7.8 years at the time of the first MRI. Four of them received methotrexate (MTX) or leflunomide (LEF).

Significant improvements occurred in TMJ movement pain (p=0.01), morning stiffness (p=0.004), opening capacity (p=0.03), and maximal incisal opening (p=0.006) during the observation period. The inflammation score decreased significantly from a median of 2 at baseline to 1 at 24 months (p=0.009).

Of the 36 TMJs, 17 (47 percent) either improved in deformity score or remained stable. The median score did not significantly increase.

“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,” the authors said.

This study was conducted between September 2018 and April 2023. Patients were included if they had a JIA diagnosis, MRI-verified TMJ arthritis leading to treatment with TNFi, MRI at 6 months and 24 months after initiation, and clinical follow-up along with an MRI by a paediatric rheumatologist and an orthodontist.