Oral health-related quality of life, impaired physical health and orofacial pain in children and adolescents with juvenile idiopathic arthritis – a prospective multicenter cohort study
Authors: Halbig Josefine M. , Jönsson Birgitta , Gil Elisabeth G. , Åstrøm Anne N. , Rypdal Veronika , Frid Paula , Augdal Thomas A. , Fischer Johannes , Cetrelli Lena , Rygg Marite , Lundestad Anette , Tylleskär Karin , Nordal Ellen ,   For the Norwegian JIA Study – Temporo-mandibular Involvement, Oral Health, Uveitis, Bone Health, Quality of Life in Children with Juvenile Idiopathic Arthritis, Rosendahl Karen , Skeie Marit Slåttelid , Nordal Ellen , Rosén Annika , Gil Elisabeth G. , Fischer Johannes , Shi Xieqi , Angenete Oskar , Lyngstad Gunnar , Sager Marie , Feuerheim Astrid J. , Augdal Thomas A. , Halbig Josefine M. , Bletsa Athanasia , Midtbø Marit , von Wangenheim Marti Larissa , Säll Mats , Luukko Keijo , Vollan Marianne Lothe , Haro Erik , Amdal Tone Kvinnsland , Eidset Susanne Irene Tobiesen , Simonsen Line Rapp , Teige Marte Grimsmo , Hansen Brita Lena , Aune Lisbeth 
Published: November 2023

Abstract
Background
Knowledge on oral health-related quality of life (OHRQoL) in children and adolescents with juvenile idiopathic arthritis (JIA) is limited, and longitudinal studies are lacking. We aimed to describe OHRQoL in children and adolescents with JIA compared to controls, and to explore the validity and internal consistency of the Early Childhood Oral Health Impact Scale (ECOHIS) and the Child Oral Impact on Daily Performance (Child-OIDP). Furthermore, we wanted to investigate associations between OHRQoL and orofacial pain, physical health, disease activity, and temporomandibular joint (TMJ) involvement in JIA.

Methods
The Norwegian prospective, multicenter cohort study recruited participants with JIA between 4 and 16 years of age and corresponding controls from three pediatric university hospital departments and public dental health services. In the present study, we analyzed OHRQoL in all children < 12 years with the ECOHIS and adolescents ≥ 12 years with the Child-OIDP at the first visit and the two-year follow-up. Associations between OHRQoL and JIA characteristics, collected in clinical exam and questionnaires, were analyzed in logistic regressions.

Results
The same OHRQoL questionnaire was completed both at first visit and two-year follow-up in 101 children < 12 years (47 JIA, 54 controls) and 213 adolescents ≥ 12 years (111 JIA, 102 controls). The frequency of OHRQoL impacts in children was similar at the first visit and the two-year follow-up (ECOHIS > 0: JIA group 81% and 85%, p = 0.791; control group 65% and 69%, p = 0.815), while adolescents with JIA reported fewer impacts at the two-year follow-up (Child OIDP > 0: JIA group 27% and 15%, p = 0.004; control group 21% and 14%, p = 0.230). The internal consistency of the OHRQoL instruments was overall acceptable and the criterion validity indicated that the instruments were valid at both visits. Orofacial pain was more frequent in children and adolescents with JIA than in controls. We found associations between OHRQoL impacts and orofacial pain, impaired physical health, disease activity, and TMJ involvement.

Conclusions
Children and adolescents with orofacial pain or impaired physical health were more likely to report impacts on daily life activities than those without. Pediatric rheumatologists and dentists should be aware of impaired OHRQoL in individuals with JIA with active disease or temporomandibular joint involvement.

Trial registration
Registered on clinicaltrials.gov (NCT03904459, 05/04/2019).