Sub-projects in NorJIA
Efficacy and safety of intraarticular corticosteroid injections in children with juvenile idiopathic arthritis and temporomandibular joint arthritis: A Norwegian multicenter pilot study (REK nr 2015/318)
PhD-student: Paula Frid
Main supervisor: Ellen B.Nordal
Co-supervisors: Tore A.Larheim, Annika Rosen, Mohammed Al Haroni
This pilot study will assess efficacy and safety of intraarticular injections (IAIs) with steroids in active temporomandibular joint (TMJ) arthritis in children with Juvenile idiopathic arthritis (JIA), together with microbiological and immunological assessments of TMJ fluid and saliva. The study is conducted as a prospective observational study. Lederspan® will be given in two different dosages based on the childs weight, either in local or general anesthesia. Maximal incisal opening (MIO), pain and MRI-findings in the TMJs will be examined before and after IAIs. Approximately 20-25 patients < 18 years will be included in this study from Tromsø, Trondheim, Bergen, Oslo and Århus.
Subprojects in NorJIA
Imaging of arthritis in the jaw in children with juvenile idiopathic arthritis
PhD-student: Oskar W Angenete, Department of circulation and medical imaging, NTNU – Norwegian university of science and technology
Main supervisor: Professor Karen Rosendahl, University of Bergen
Co-supervisors: Marite Rygg and Knut Haakon Stensæth, NTNU
The aim of the study is to better define the role of magnetic resonance imaging (MRI), both as a tool in diagnostics and in follow-up of arthritis in the jaw in patients with juvenile idiopathic arthritis. Assessing inflammation in the jaw can be a difficult task for both the patient and the pediatric rheumatologist. Defining the extent of the inflammation can be even harder.
MRI has the potential to inform the pediatric rheumatologist on both the degree of inflammation as well as the structural damage the inflammation might have caused in the joint. This ability is, so far, exclusive to MRI compared to other imaging tools. However, the knowledge on MRI features determining which joint is affected by arthritis and which is not, is sparse. The reliability and usefulness of these features is also not entirely known.
The present study aims to address this topic in 4 separate publications:
1.What MRI features define a normal jaw in children without juvenile idiopathic arthritis and which of these features are reliable?
2.Is a dynamic, contrast-enhanced sequence feasible and useful in MRI of the jaw in children with juvenile idiopathic arthritis?
3.A newly devised MRI-based scoring system for arthritis of the jaw in children with juvenile idiopathic arthritis; is it reliable?
4.Is there a correlation between the MRI findings and the clinical findings of the jaw in children with juvenile idiopathic arthritis?
Subprojects in NorJIA
Oral health in juvenile idiopathic arthritis (JIA) – A longitudinal study (REK no. 2012/542)
PhD-student: Lena Cetrelli, DDS(tannlege) – Støren Public Dental Office (Støren Tannklinikk), PhD.student at TkMN (Tannhelsetjenestens Kompetansesenter i Midt-Norge/Oral Health Centre of Expertise in Mid-Norway)
Main supervisor (hovedveileder): Professor Marite Rygg, Department of Clinical and Molecular Medicine, NTNU – Faculty of Medicine and Health Sciences, and Department of Pediatrics, St. Olavs Hospital
Co-supervisors (biveiledere): Astrid Jullumstrø Feuerherm, senior researcher at TkMN, Athanasia Bletsa, researcher at TkVest-Hordaland and Associate professor- Department of Clinical Dentistry, University of Bergen. Professor Pål Richard Romundstad, Department of Public Health and Nursing (ISM), NTNU
Little is known about many of the factors associated with the oral health of children with juvenile idiopathic arthritis (JIA). It has been reported that many of the children with JIA have more dental cavities, lower production of saliva and lower vitamin D levels. However, small numbers of JIA participants and lack of healthy children as controls are the most common drawbacks of the known literature.
This study aims to investigate if there are differences in oral health of JIA children compared to healthy children. It’s a longitudinal study, in which 250 children with JIA and 200 healthy children are examined twice, with two years interval. This makes it possible to see if there are differences in oral health and how these differences develop over time. We hope to find some factors that could be helpful in identifying the children that are at risk of developing poor oral health. This may lead to suggestions of prophylactic measures that could help in sustaining a good oral health in this patient group.
The first examination is ongoing and will end in January 2018. The second examination starts in March 2018. This PhD-study is estimated to be finished by the end of 2021.
Subprojects in NorJIA
Bone Health in juvenile idiopathic arthritis (JIA)
Resident during specialization: Anette Lundestad, Department of Pediatrics, St. Olavs Hospital
Main supervisor: Professor Marite Rygg, Department of Clinical and Molecular Medicine, NTNU – Norwegian University of Science and Technology and Department of Pediatrics, St. Olavs Hospital
Co-supervisors: Post-doctor Mari Hoff, Department of Public Health and Nursing, NTNU and Department of Rheumatology, St. Olavs Hospital, and associate professor Gry Børmark Hoftun, Department of Clinical and Molecular Medicine, NTNU and Department of Pediatrics, St. Olavs Hospital
The foundation for a good bone health and a strong skeleton is made during childhood and adolescence, and is dependent on several factors like diet, physical activity, genes and a generally good health. A chronic inflammatory condition like juvenile idiopathic arthritis (JIA) may affect several of these factors. In addition, we know that inflammation in itself and several anti-inflammatory drugs may have negative impact on the bone health.
The goal for this sub-study is to examine if Norwegian children and adolescents with JIA have reduced bone mass compared to healthy age- and gender-matched peers. Furthermore, we want to find out which factors that are associated to reduced bone mass in order to suggest prevention acts for the children at risk for developing a poorer bone health with a potential risk for osteoporosis later in life.
We plan to study the following questions in several publications:
1.Is there a difference between the bone mass in children and adolescents with JIA compared to healthy age- and gender-matched peers, and how do we measure this in the most precise and easy way?
2.Which disease factors affect the bone mass? Does other factors, like calcium and D vitamin intake and physical activity level, differ between adolescents with JIA compared to healthy age- and gender-matched peers?
3.Can biomarkers help us to predict whom among children and adolescents with JIA, are at risk of developing low bone mass and poorer bone health?
Sub-projects in NorJIA
Oral health-related quality of life (OHRQoL) in Norwegian
children with juvenile idiopathic arthritis: A Norwegian longitudinal, multicenter, case-control study
PhD-student: Josefine Mareile Halbig
Main supervisor: Ellen Berit Nordal - Associate professor (UiT - The Arctic University of Norway), Consultant Pediatric Rheumatologist (UNN – University hospital of Northern Norway), PhDCo-supervisors: Birgitta Jönsson - Researcher, PhD, RDH (The Public Dental
Health Service Competence Centre of North Norway),
Associate Professor (Institution of Odontology at the Sahlgrenska Academy, University of Gothenburg, Sweden) and Kasper Dahl Kristensen - Guest Researcher, Section of Orthodontics, HEALTH. Aarhus University DDS, certified orthodontist, PhD
Oral health-related quality of life (OHRQoL) is a multidimensional concept representing a combination of general health, perceptions of actual or potential health, and/or disability. The overall aim of this study is to increase knowledge on oral health and oral health-related quality of life in children with JIA to improve diagnosis, follow up, and treatment.
Oral diseases and conditions, including craniofacial anomalies, have broad impact on oral health and wellbeing. Furthermore, OHRQoL is recognized by the WHO as an integral part of general health and should be taken in consideration when studying oral health.
Temporomandibular joint (TMJ) arthritis and Temporomandibular dysfunction (TMD) are common findings in children with JIA.TMD and orofacial pain often causes reduced daily functioning and quality of life.TMJ-involvement with and without growth disturbance can lead to difficulties in chewing, mouth opening, and performing oral hygiene properly, which can lead to poor oral health and may have an impact on OHRQoL.
The present study aims to address this topic in three separate publications with the following goals:
1.Investigate oral health and OHRQoL in children diagnosed with JIA compared to health controls and describe changes over a two-year period.
2.Determine the prevalence and changes of gingivitis and periodontitis in children diagnosed with JIA and in healthy controls in relation to medication and OHRQoL.
3.Describe the prevalence of TMD in children with JIA and in healthy controls, determine change of TMD manifestation over time, and investigate the influence of TMD on OHRQoL.
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