People with juvenile idiopathic arthritis (JIA) who experience orofacial pain — pain in the mouth, face, and jaw — have more stress, limitations on daily activities, disease activity, and systemic inflammation than those who do not, a study reports.
The study, “Orofacial pain in juvenile idiopathic arthritis is associated with stress as well as psychosocial and functional limitations,” was published in the journal Pediatric Rheumatology.
The hallmarks of JIA are swelling of the joints, pain, and stiffness, typically in the knees, hands, or feet. JIA can affect other joints as well, such as those that connect the jaw to the head, which are known as the temporomandibular joints (TMJ).
Up to 96% of children with JIA develop TMJ arthritis, where stiffness, crepitus (joint popping), and restricted mouth opening are often reported.
Chronic or recurrent pain and disability in children and adolescents can limit their ability to function and grow properly. Many of these patients refrain from going to school and avoid engaging in social activities due to the psychosocial stress and pain associated with the disorder.
To investigate the relationship between psychosocial stress, along with inflammatory activity, and pain and function of the jaw, a group of researchers in Sweden studied 45 JIA patients ages 6 to 16. Sixteen children without JIA were also included as controls.
A clinical assessment, including both a physical and a psychosocial component, was conducted on all participants by one dentist.
Pain intensity and pain-related disability were assessed with the Graded Chronic Pain Scale. Limitations to jaw function was evaluated using the Jaw Functional Limitation Scale.
A four-item Patient Health Questionnaire was used to assess depression and anxiety symptoms. The Pain Catastrophizing Scale was applied to determine the degree of catastrophizing (believing pain is worse than it is), and the 10-item Perceived Stress Scale was used to evaluate stress.
The Childhood Health Assessment Questionnaire was used to assess ability to conduct daily life activities among children with JIA, while the body-drawing part of the McGill Pain Questionnaire was used to record pain locations.
Finally, the team used the Juvenile Arthritis Disease Activity Score, which includes an active joint count, a physician global assessment, a parent global evaluation, and the erythrocyte sedimentation rate (an indicator of systemic inflammation).
Results showed a strong association between experiencing orofacial pain and stress. Among patients scoring higher (worse) than “normal” in perceived stress, eight out of ten had self-reported orofacial pain.
Orofacial pain also significantly correlated with pain-related disability, depression, pain catastrophizing, and limitations in daily activities.
The team then compared clinical and psychosocial factors of JIA patients who experienced jaw pain with those who did not.
Orofacial pain was significantly associated with pain intensity, maximum mouth opening, and limitations on jaw functioning. JIA patients with orofacial pain also had higher disease activity and systemic inflammation than those without such pain.
In contrast, neither depression nor pain catastrophizing were linked to orofacial pain.
“This study indicates that orofacial pain in patients with JIA is associated with stress, psychological distress, jaw dysfunction and loss of daily living activities,” the researchers said. “Pain intensity seems to be the major aspect related to these factors. … In addition, increased disease activity with more joint involvement seems to be an important factor contributing to orofacial pain in JIA.”