Effect of functional therapy and ohrqol of patients affected by juvenile idiopathic arthritis

The objective of the study was to evaluate the impact of temporomandibular joint (TMJ) arthritis on the functional disability and quality of life in patients affected by juvenile idiopathic arthritis (JIA). Juvenile idiopathic arthritis (JIA) is a chronic disease of unknown ethiology, with an estimated incidence of 16 to 150 cases per 100 000 children worldwide. Temporomandibular joint (TMJ) arthritis is a common consequence of the systemic disease in patients with JIA. Methods: Sixty-two consecutive patients with JIA with or without TMJ arthritis and 35 healthy control subjects were enrolled in the study. The demographic data, disease activity and clinical characteristics were obtained from all patients. The functional disability was assessed using the Italian version of the Childhood Health Assessment Questionnaire (C-HAQ). The oral health-related quality of life (OHRQoL) was assessed using the Child Perception Questionnaire (CPQ11-14). Possible determining factors of TMJ arthritis comprised demographic, disease characteristics and scores derived from questionnaires that were assessed by a uni and multivariable logistic regression analysis. All statistical analyses were executed using a software program (SPSS version 17.0 for Windows, Chicago, IL). The parametric approach was used because the data are normally distributed, as verified by the Kolmogorov– Smirnov test. The chi-square test and the t-test were used to compare the categorical and the continuous variables, respectively. A univariable logistic regression analysis was used to assess the influence of the quality of life measurements on TMJ involvement. The same analysis was performed in order to recognize factors distinguishing JIA patients with the presence/absence of TMJ arthritis by using the C-HAQ and CPQ11-14 domains as exploratory measures. To recognize factors independently associated with TMJ arthritis, multivariable logistic regression was performed. Results: The demographic data, age and gender distribution, JIA types, drug therapy and the serological values of the sample are presented for a total of 88 patients participated in the study; 32 patients in the JIA +TMJ group,30 patients in the JIA group and 26 patients in the control group. The examined groups were matched for age and gender. Compared with patients without TMJs arthritis, JLA patients with TMJ arthritis presented higher functional disability. The multivariable logistic regression analysis performed showed that female subjects (OR = 1.5, P = 0.041), with a JIA duration over 3.9 years (OR = 2.7, P = 0.033) and presenting higher C-HAQ and CPQ11-14 scores (OR = 2.7, P = 0.012 and OR = 2.9, P = 0.015,respectively) were the greatest determining factors for TMJ arthritis. Conclusions: JIA patients with TMJ arthritis presented a significant higher functional disability and daily difficulties and lower OHRQoL scores compared with JIA patients without TMJ arthritis. TMJ arthritis was associated with high JIA duration and activity and influenced some activities, such as eating, hygiene, emotional and social well-being, especially in female subjects.