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  • 1.
    Carlsson, Alexandra Dimitrijevic
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Linkoping Univ, Ctr Oral Rehabil Linkoping, Linkoping, Sweden.;Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden.;Scandinavian Ctr Orofacial Neurosci, Malmo, Sweden..
    Wahlund, Kerstin
    Kalmar Cty Hosp, Dept Stomatognath Physiol, Kalmar, Sweden..
    Kindgren, Erik
    Vasterv Hosp, Dept Pediat, Vastervik, Sweden.;Linkoping Univ, Dept Clin & Expt Med, Div Pediat, Linkoping, Sweden.;Skaraborg Hosp, Dept Pediat, Skovde, Sweden..
    Skogh, Thomas
    Linkoping Univ, Dept Clin & Expt Med, Div Neuro & Inflammat Sci, Linkoping, Sweden..
    Johansson, Carin Starkhammar
    Linkoping Univ, Ctr Oral Rehabil Linkoping, Linkoping, Sweden.;Linkoping Univ, Dept Biomed & Clin Sci, Linkoping, Sweden..
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD). Scandinavian Ctr Orofacial Neurosci, Malmo, Sweden.;Skane Univ Hosp, Specialized Pain Rehabil, Lund, Sweden.;Malmo Univ, Orofacial Pain Unit, Malmo, Sweden..
    Orofacial pain in juvenile idiopathic arthritis is associated with stress as well as psychosocial and functional limitations2019Ingår i: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 17, nr 1, artikel-id 83Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The aim of this study was to investigate relations between psychosocial factors, signs and symptoms of orofacial pain and jaw dysfunction in patients with juvenile idiopathic arthritis (JIA). Methods Forty-five patients with JIA (median age 12 years) and 16 healthy matched controls (median age 13 years) were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered the DC/TMD questionnaires regarding psychosocial factors (pain intensity, pain-related disability, depression, stress, catastrophizing, pain locations and jaw function). Results JIA patients with orofacial pain had higher degree of stress, depression, catastrophizing and jaw dysfunction compared to subjects without. In turn, these factors were associated with orofacial pain intensity. Also, patients with orofacial pain had higher systemic inflammatory activity. Conclusions Orofacial pain in patients with JIA is associated with stress, psychological distress, jaw dysfunction and loss of daily living activities. Pain intensity seems to be the major pain aspect related to these factors. In addition, systemic inflammatory activity appears to be an important factor contributing to orofacial pain in JIA.

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  • 2.
    Dimitrijevic Carlsson, Alexandra
    Malmö universitet, Odontologiska fakulteten (OD).
    The Temporomandibular Joint in Juvenile Idiopathic Arthritis: Psychosocial, clinical, imaging and parotid saliva biomarkers2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Juvenil idiopatisk artrit (JIA) är ett samlingsbegrepp för kroniska ledinflammatoriska sjukdomar hos barn. I Sverige insjuknar årligen ungefär 200 barn. För att få diagnosen JIA skall debuten ske före 16 års ålder. Vid JIA kan de flesta leder drabbas med olika problem som följd. Den här avhandlingen fokuserar på käkleden där inflammation (käkledsartrit) på grund av JIA kan orsaka smärta, brosk- och bennedbrytning och nedsatt käkfunktion. Inflammationen kan även påverka tillväxt så att patienterna kan få en liten haka och öppet bett. Samtidigt är det så att många barn med JIA i käkleden inte upplever några symtom, trots en pågående käkledsinflammation. Detta gör det mycket svårt att upptäcka sjukdomen i käkleden tidigt. Idag saknas etablerade och validerade kliniska diagnostiska kriterier för att identifiera patienter med käkledsartrit. Det betyder att metodik för att undersöka patienter och definition av käkledsartrit vid JIA varierar avsevärt, både i det kliniska arbetet och i vetenskapliga studier samt mellan olika kliniker och länder. Syftet med denna avhandling var att undersöka hur smärta och funktion i käksystemet relaterar till generell inflammatorisk aktivitet, biomarkörer i parotissaliv och blod, inflammatoriska förändringar i käkled och psykosociala faktorer, både vid första undersökningen och över en två-årsperiod. Avhandlingen visar bland annat att smärta i käksystemet har tydliga samband med stress och nedsatt käkfunktion där smärtintensiteten verkar vara den viktigaste faktorn. Ökad stress över en två-årsperiod är associerad med försämrad käkfunktion och mående. Det finns ett överlapp av fynd på magnetkamera vad gäller käkledsförändringar mellan patienter med JIA och friska kontroller. Hos patienterna med JIA förefaller benmärgsöden i käkledshuvudet vara relaterat till smärta i käksystemet. När det gäller de inflammationssubstanser vi undersökte i saliv visar denna avhandling att Interleukin-6-familjen möjligen kan ha egenskaper som biomarkör relaterat till benmärgsödem i käkledshuvudet. Sjukdomen JIA är en klinisk utmaning att identifiera, diagnostisera, följa och behandla vad gäller käkleden. Här behövs mycket mer forskning där ett viktigt steg är att etablera valida diagnostiska kriterier. De drabbade barnen kan idag få stora skador i käkleden, ibland med associerad smärta och nedsatt käkfunktion. Sammanfattningsvis visar avhandlingen att stress samt smärta och käkfunktion i hela käksystemet är viktiga faktorer att undersöka och ta med i den kliniska bedömningen och behandlingen. Det överlapp av fynd från käkleden vid undersökning med magnetkamera mellan barn med JIA och friska kontrollen innebär att man behöver tolka fynd från magnetkamera med försiktighet.

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  • 3.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Center For Oral Rehabilitation, Torkelbergsgatan 11, 581 85 Linköping, Department of Biomedical and Clinical Science, Linköping University; postal code 581 83 Linköping, Sweden.
    Ghafouri, Bijar
    Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, 58183 Linköping, Sweden.
    Starkhammar Johansson, Carin
    Center For Oral Rehabilitation, Torkelbergsgatan 11, 581 85 Linköping, Department of Biomedical and Clinical Science, Linköping University; postal code 581 83 Linköping, Sweden.
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD). Orofacial Pain and Jaw Function, Institute of Dental Medicine, Karolinska Institute, Alfred Nobels allé 8, 141 52 Huddinge, Sweden; Specialized Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 222 41 Lund, Sweden.
    Unstimulated Parotid Saliva Sampling in Juvenile Idiopathic Arthritis and Healthy Controls: A Proof-of-Concept Study on Biomarkers2020Ingår i: Diagnostics (Basel), ISSN 2075-4418, Vol. 10, nr 4, artikel-id 251Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aims of this proof-of-concept study were to develop a collecting method for unstimulated parotid saliva in juvenile idiopathic arthritis (JIA) patients and healthy children and to investigate if inflammatory biomarkers could be detected in these samples. Forty-five children with JIA (median age of 12 years and 25th-75th percentile of 10-15 years; 33 girls and 12 boys) and 16 healthy children as controls (median age of 13 years and 25-75th percentile of 10-13 years; 11 girls and 5 boys) were enrolled in this study. Unstimulated parotid saliva was collected with a modified Carlson-Crittenden collector. The salivary flow rate and salivary concentrations of total protein and inflammatory mediators were assessed. The Meso Scale Discovery electrochemiluminescence immunoassay was used for analyzing protein concentrations and the inflammatory biomarkers. Sufficient parotid saliva volumes to be analyzed could be collected with the collection device. JIA patients had a lower sampling saliva volume (p = 0.008) and saliva flow rate (p = 0.039) than controls. The total protein concentrations and inflammatory biomarkers were measured in the last six healthy subjects. The median protein concentration was 1312 mu g/mL (25th percentile: 844 mu g/mL and 75th percentile: 2062 mu g/mL; n = 6) and quantifiable concentrations of 39 inflammatory proteins could be assessed in these samples. In conclusion, this study indicates that the saliva sampling method, as used in the present study, is able to collect sufficient sample volumes in children, and that it is possible to analyze various inflammatory biomarkers in the collected saliva.

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  • 4.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). 2 Center for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, ; Scandinavian Center for Orofacial Neurosciences, Malmö.
    Wahlund, K
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar.
    Klintström, E
    Center for Medical Image Science and Visualization (CMIV) and Department of Radiology in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University.
    Salé, H
    Department of Neuroradiology, Center of Medical imaging and Physiology, Skåne University Hospital, Lund.
    Kindgren, E
    Department of Pediatrics, Västervik Hospital, Västervik; Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping; Department of Pediatrics, Skaraborg Hospital, Skövde.
    Starkhammar Johansson, C
    Center for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping,.
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD). Scandinavian Center for Orofacial Neurosciences, Malmö; Skåne University Hospital, Specialized Pain Rehabilitation, .
    Juvenile idiopathic arthritis and the temporomandibular joint: a case-control study of magnetic resonance imaging findings in relation to clinical and psychosocial factors.2023Ingår i: European Journal of Paediatric Dentistry, ISSN 1591-996X, E-ISSN 2035-648X, Vol. 24, nr 1, s. 69-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: In juvenile idiopathic arthritis (JIA), the temporomandibular joint (TMJ) is a particularly challenging joint to assess both clinically and with imaging. The aim of this article is to investigate TMJ magnetic resonance imaging (MRI) findings in relation to clinical and psychosocial factors in patients with JIA and healthy individuals related to TMJ arthritis in JIA.

    MATERIALS: In total, 45 patients (6-16 years) with JIA and 16 healthy age- and sex-matched controls were examined according to the diagnostic criteria for temporomandibular disorders (DC/TMD). The subjects answered questionnaires about psychosocial factors (pain intensity, pain-related disability, depression, stress, catastrophising, pain locations, and jaw function) and underwent bilateral MRI of the TMJ.

    RESULTS: There were no significant differences between JIA patients and healthy individuals in any of the TMJ MRI findings. Moderate/severe changes among JIA patients were found only for effusion, synovial thickening, condylar flattening, and erosion, with no moderate/severe changes in healthy individuals. In JIA patients, orofacial pain intensity was related to TMJ bone marrow oedema, and pain in jaw muscles during jaw function was related to TMJ bone marrow oedema and erosion. There were no significant correlations between psychosocial aspects and MRI findings.

    CONCLUSION: This study indicates a substantial overlap of TMJ MRI findings in both the inflammatory domain and the damage domain between JIA patients and healthy individuals. In JIA patients, the inflammatory MRI sign of bone marrow oedema seems to influence orofacial pain intensity.

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  • 5.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö universitet, Odontologiska fakulteten (OD).
    Wahlund, Kerstin
    Ghafouri, Bijar
    Kindgren, Erik
    Frodlund, Martina
    Salé, Hanna
    Klintström, Eva
    Starkhammar Johansson, Carin
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD).
    Parotid saliva and blood biomarkers in juvenile idiopathic arthritis inrelation to temporomandibular joint magnetic resonance imaging findingsManuskript (preprint) (Övrigt vetenskapligt)
  • 6.
    Dimitrijevic Carlsson, Alexandra
    et al.
    Malmö universitet, Odontologiska fakulteten (OD). Centre for Oral Rehabilitation, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Wahlund, Kerstin
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden.
    Kindgren, Erik
    Department of Pediatrics, Västervik Hospital, Västervik, Sweden; Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden.
    Frodlund, Martina
    Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD). Scandinavian Center for Orofacial Neurosciences; Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden.
    Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study2024Ingår i: Pediatric Rheumatology, E-ISSN 1546-0096, Vol. 22, nr 1, artikel-id 30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundStress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA.MethodsThis is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors.ResultsChange in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function.ConclusionsThis study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.

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  • 7.
    Starkhammar Johansson, C
    et al.
    Center for Oral Rehabilitation, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Dimitrijevic Carlsson, Alexandra
    Malmö universitet, Odontologiska fakulteten (OD). Center for Oral Rehabilitation, Department of Biomedical and Clinical Sciences, Linköping University, Linköping.
    Wahlund, K
    Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden.
    Alstergren, Per
    Malmö universitet, Odontologiska fakulteten (OD). Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden.
    Periodontal Health in Children with Juvenile idiopathic arthritis2024Ingår i: European Journal of Paediatric Dentistry, ISSN 1591-996X, E-ISSN 2035-648X, Vol. 25, artikel-id 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To investigate gingival inflammation and prevalence of four specific periodontal associated pathogens in Juvenile idiopathic arthritis (JIA) in relation to orofacial pain, jaw function and systemic inflammatory activity in JIA.

    METHODS: Forty-five children with JIA and 16 healthy children as controls, were enrolled. Subjects were examined and classified according to the diagnostic criteria for temporomandibular disorders (DC/TMD). Pain, pain-related disability and jaw function were also assessed. A clinical periodontal examination was performed. Subgingival plaque samples were collected and analyzed for semiquantitative levels of the following periodontal pathogens; Aggregatibacter actinomycetemcomintans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola.

    RESULTS: No significant difference between JIA and healthy individuals was observed regarding the clinical periodontal variables plaque, gingivitis, probing pocket depth or the investigated periodontal pathogens. P. gingivalis and T. forsythia were detected in both groups. In the group with JIA, no significant correlation was found between orofacial pain, jaw function, systemic inflammatory activity and periodontal disease, including levels of P. gingivalis and T. forsythia. 

    CONCLUSION: This study suggests that the periodontal disease-associated bacteria P. gingivalis and T. forsythia do not contribute to neither periodontal disease, systemic inflammatory activity nor orofacial pain and jaw dysfunction, including TMJ arthritis, in JIA patients in Sweden.

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