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 – Støren Public Dental Office (Støren Tannklinikk), PhD.student at TkMN (Tannhelsetjenestens Kompetansesenter i Midt-Norge/Oral Health Centre of Expertice in Mid-Norway)

Main supervisor:

Marite Rygg, Professor, Department of Clinical and Molecular Medicine, NTNU – Faculty of Medicine and Health Sciences, and Department of Pediatrics, St. Olavs Hospital

Co-supervisors:

Astrid Jullumstrø Feuerherm, senior researcher TkMN.           

Athanasia Bletsa, researcher at TkVest-Hordaland and Associate professor Department of Clinical Dentistry, University of Bergen. 

Pål Richard Romundstad, Professor, 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 differences in oral health of JIA children compared to healthy children, including a larger number of patients and controls. It’s a longitudinal study, in which 224 children with JIA and 224 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 was finished in January 2018. The second examination is ongoing and estimated to be completed by January 2020. Data from the first examination is now being analyzed. This PhD-study is estimated to be finished by the end of 2021.

We plan to study the following questions in several publications:

1. Vitamin D levels, enamel defects and caries in JIA, and association to inflammatory activity compared to  

     healthy controls

2. Salivary biomarkers for oral health in a Norwegian cohort study of JIA

3. Oral health in JIA as compared to healthy controls – A longitudinal study

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?