EFFECTS OF POLYARTICULAR AND PAUCIARTICULAR ONSET JUVENILE RHEUMATOID-ARTHRITIS ON FACIAL AND MANDIBULAR GROWTH

Objective. To characterize the functional and morphologic effects of p olyarticular and pauciarticular onset juvenile rheumatoid arthritis (J RA) on the temporomandibular joint (TMJ). Methods. Medical and dental histories, intraoral, lateral cephalometric, and panoramic radiographs , facial photographs, and dental study models were obtained for each o f 30 patients with JRA (17 pauciarticular and 13 polyarticular onset). Measures of TMJ dysfunction were gathered during the clinical examina tion, and an index of condylar morphology was inferred from the panora mic radiographs. The lateral cephalograms were traced, and data from 3 4 linear and angular measures used to compare the facial morphology of the 2 JRA onset types, both to normative standards and to each other (Student's t test). The Kruskal-Wallis test was used to evaluate the s ignificance of between group differences for the various ordinal indic es. Results. As indicated by the higher TMJ dysfunction and condylar i ndex scores, polyarticular onset JRA affects the form and function of the TMJ more frequently and severely than does pauciarticular onset. M oreover, compared to normative cephalometric standards, the patients w ith polyarticular onset had small, short faces with underdeveloped man dibles. Conclusion. Both polyarticular and pauciarticular onset JRA ha ve a negative effect on the form, function, and esthetics of the face and mandible; however, the effects are more pronounced with polyarticu lar JRA than pauciarticular onset.