When You Can’t Smile to Hide the Pain

Psoriatic arthritis can involve many joints. Some of the more common ones include knees, fingers, toes, and lower back. But did you know that psoriatic arthritis can also affect your jaw – the temporomandibular joint (TMJ)?

As parents raising a child with juvenile psoriatic arthritis, my husband and I wish this had been on our radar from the start. It would have put my son’s symptoms into perspective, and we could have gotten him help sooner, rather than later.

Though diagnosed at age 5 with juvenile arthritis, we can look back and see signs of the disease years earlier. Toddler pictures show a skinny kid with swollen knees. He never crawled, always rolling from one end of the living room to the other. He fell often when running and jumping, for what appeared to be no reason at all.

Clumsy? Could be. After all, he had my genes. After his diagnosis, we were able to put the puzzle pieces together and blame most of his physical issues on juvenile arthritis.

Speaking clearly

But, that didn’t explain my child’s speech. During elementary school, his speech was mumbled. I would get frustrated and had to ask him to repeat what he just said. “Speak clearly” was a phrase uttered in our house often.

When we sought a 504 Plan (school accommodations due to juvenile arthritis and psoriasis) when he was in third grade, my son was evaluated for speech. The speech therapist believed that he did not need intervention, but rather his mumbling would improve as he got older.

Food challenges

You expect kids to go through phases of being picky eaters, but refusing to eat altogether was something new. Though never complaining of pain, my son would simply choose to not eat. You couldn’t even tempt him with his favorite foods. As a parent, this concerned me greatly, especially since he was such a thin kid to start with.

Say cheese!

In the early years, we’d have to tell our son, “No monster smiles!” when he would get his picture taken. You know those funny kid smiles where all you see are teeth. As he got older, we’d have to beg him to show any teeth at all. He didn’t mind his photo taken, but sporting a grin was painful. When he did muster up the courage to smile through the pain, his eyes would show what was going on behind the scenes.

Getting treatment

Now in high school, the puzzle pieces finally started coming together, and his pediatric rheumatologist referred him to a pediatric maxillofacial surgeon. Wow, that title is a mouthful! (Pun intended.) After x-rays and physical exams, the doctor determined that my son indeed had arthritis in his jaw and that he was a good candidate for TMJ injections.

This meant the doctor would go in and flush out his TMJ joints to help rid the inflammation. Then the doctor would inject steroids directly into his jaw to finish the procedure. Thankfully, my son never needed reconstructive surgery, as joint damage wasn’t severe. However, this procedure isn’t a one and done type of treatment. The doctor said most likely, my son would need to repeat these injections, maybe as often as every six months.

The doctor also advised against braces until the arthritis was under control. Today, my son still has crooked teeth because he’s never been without jaw pain for longer than a year.

After the injections, my son turned into a more outgoing, smiley kid. He clearly benefited, both physically and socially. He finally knew what it felt like to not be in pain.