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


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?

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.



Sub-projects in NorJIA


Juvenile idiopathic arthritis from childhood to young adulthood. Aspects of disease activity and uveitis


PhD- candidate: Veronika Rypdal, MD.Department of Pediatrics, University Hospital of North Norway, Tromsø.

Supervisor: Ellen Berit Nordal, MD., PhD. Department of Pediatrics, University Hospital of North Norway, Tromsø. Department of Clinical Medicine, UiT– The Arctic University of Norway, Norway. 


Juvenile idiopathic arthritis (JIA) is a very heterogeneous group of chronic childhood arthritis. The most common extraarticular manifestation is uveitis. Uveitis affects up to 20 % of children with juvenile idiopathic arthritis (JIA) The etiology of both JIA and associated uveitis is unknown. Uveitis may lead to serious sight-threatening complications, and thus the long-term prognosis of these children may be severely affected. Uveitis associated with JIA is mostly asymptomatic, and regular ophthalmologic examinations are necessary to ensure prompt diagnosis and start of treatment. Antinuclear antibodies (ANA) have been suggested as a disease determinant to identify a homogeneous disease group at risk for developing uveitis. Antihistone-antibodies (AHAs) are the most prevalent subtype of ANA in JIA-patients.

We want to investigate clinical risk factors and antihistone-antibodies as clinically useful marker to predict children at high risk of developing uveitis, and explore risk factors of ongoing uveitis activity and AHAs relation to uveitis.


Sub-projects in NorJIA

Juvenile idiopathic arthritis with temporomandibular disorder and its correlation to clinical pain and imaging markers (2012/542/REK vest)


Johannes M. Fischer, Phd-fellow and Specialist candidate in orthodontics, University of Bergen (UiB)

Main supervisor: Annika Rosen

Co-supervisors: Marit Slåttelid Skeie, Karen Rosendahl


In Scandinavia, temporomandibular disorder (TMD) and temporomandibular joint disease (TMJD) among adolescents with JIA was reported for the first time in 1988. Few studies have since then evaluated TMD in JIA patients, a German study from 2003 reported a prevalence of TMD in juvenile patients with rheumatic disease by 54% percent while a Brazilian study from 2012 focusing on 16-year-olds with JIA, estimated the prevalence to be 83%. However, clinical examination of the TMJ is inaccurate, and there are lacking standardized, validated, and feasible assessment systems to guide treatment decisions and provide accurate and science-based information on prognosis to patients and their families. This multicenter study apply examinations tools which  distinguish the presence of selfreported main complaints related to clinical pain trigerred by opening-, lateral- and protrusive movements and by palpation of the masticatory muscles as well as the TMJ.  Clinical examination alone does not seem sufficiently sensitive in detecting TMJ arthritis, and radiologic imaging techniques as magnet resonance imaging (MRI), cone beam computet tomography (CBCT) and orthopantomography (OPT) are recommended. There is a demand to corroborate clinical diagnoses in the field of TMJD with radiologic imaging techniques, establishing an imaging scoring system to evaluate associations between clinical TMJ pain for active and chronic diseaseand find imaging markers for mandibular growth disturbances.

This sub-project aims to evaluate the prevalence of TMD and TMJD in children and adolescents with JIA, to compare the findings with peers without JIA, creating an imaging scoring system for registration of possible changes of TMJ components in JIA patients applying MRI and CBCT,establishing imaging markers for mandibular growth disturbances and finally analyze clinical as well as radiographic characteristics of each JIA subtype.


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