Kiefergelenkarthritis bei Kindern mit juveniler idiopathischer Arthritis – frühzeitige Diagnose und Behandlung

Zusammenfassung

Die Diagnose der Kiefergelenksarthritis ist eine große Herausforderung, insbesondere in der Frühphase der Erkrankung, bevor es zu strukturellen Veränderungen wie Wachstumsstörungen gekommen ist. Schmerzen sind als Symptom zu unzuverlässig und unspezifisch. Die Bewegungseinschränkung in Form einer reduzierten Mundöffnung ist zwar oft vorhanden, aber wegen der großen Streubreite der Normalwerte schlecht verwertbar. Eine Schwellung oder ein Gelenkserguss sind selten vorhanden. Leider hat sich auch der Ultraschall für die Diagnose der frühen Arthritis nicht bewährt, so dass vorläufig nur die MRT als Methode für die Frühdiagnose der Kiefer­gelenksarthritis empfohlen werden kann.

Die Therapie richtet sich nach der Gesamtaktivität der Arthritis bei einem individuellen Patient: Sind nur wenige Gelenke betroffen, wird man zunächst intra-artikuläre Steroidinjektionen wählen, welche gut wirksam und einfach durchzuführen sind. Kinder mit mehr Arthritis-Aktivität profitieren von einer systemischen Immunsuppression, z. B. mit Methotrexat. Aufgrund neuerer Daten ist von wiederholten Steroidinjektionen innerhalb kurzer Zeit abzuraten.

Abstract

The diagnosis of temporomandibular joint arthritis remains a challenge especially at an early stage of the disease before structural changes such as growth disturbances have already occurred. Pain is an unreliable and very unspecific symptom. A restricted movement with decreased mouth opening capacity is very common, but the interpretation is difficult because of the large range of normal values. Swelling or joint effusion are uncommon findings, and unfortunately also ultrasound is not able to reliably detect early temporomandibular arthritis. Therefore, magnetic resonance imaging remains the only method recommendable for an early diagnosis.

The choice of treatment is based on the general arthritis activity of an individual patient: if only few joints are involved, intra-articular steroid injections are a quick and effective option. Children with more joints involved will benefit from systemic immunosuppressive drugs such as metho­trexate. Based on more recent findings repeated steroid injections should be avoided.

Schlüsselwörter

Kiefergelenkarthritis - juvenile idiopathische Arthritis

Key words

temporomandibular joint arthritis - juvenile idiopathic arthritis

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