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Observational Study
. 2015 Dec 21:13:62.
doi: 10.1186/s12969-015-0060-6.

Temporomandibular joint steroid injections in patients with juvenile idiopathic arthritis: an observational pilot study on the long-term effect on signs and symptoms

Peter Stoustrup  1 , Kasper Dahl Kristensen  2   3 , Annelise Küseler  4   5 , Thomas Klit Pedersen  6   7 , Troels Herlin  8
Affiliations
Observational Study

Temporomandibular joint steroid injections in patients with juvenile idiopathic arthritis: an observational pilot study on the long-term effect on signs and symptoms

Peter Stoustrup et al. Pediatr Rheumatol Online J. .

Abstract

Background: Temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA) can lead to orofacial pain and malfunction of the TMJ. Intra-articular corticosteroid injections (IACI) have been suggested as a treatment modality against TMJ arthritis-related orofacial signs and symptoms. However, knowledge of the effect-durability of these injections remains unanswered. The aim of this pilot study was to evaluate the short and long-term effects of IACI on orofacial symptoms in a prospective observational study based on pre-specified clinical examination standards.

Methods: Thirteen patients with JIA and arthritis-related orofacial signs and symptoms were included in this prospective pilot study (median 17.2 years, IQR 15-18.4 years). All patients received TMJ IACI (11 bilateral and two unilateral) due to an insufficient response to previous pain-management treatments. Three standardized clinical examinations were carried out: T1 prior to treatment, T2 short-term follow-up (mean 34 days post-treatment), T3 long-term follow-up (mean 333 days post-treatment).

Results: Significant pain reduction was observed at the short-term follow-up (T2). Resolution of orofacial pain after IACI was a rare finding at T2. Generally, the pain significantly worsened between T2 and T3 examinations. The reported pain levels rose between T2 and T3 indicating a loss of effect of the IACI at the long-term follow-up examination (T3). Non-significant improvements in TMJ mobility were observed at T2 and T3.

Conclusion: Our results suggest a palliative (not curative) effect of IACI for TMJ arthritis-related orofacial symptoms in patients with long-term orofacial pain complaints. The short-term improvements in signs and symptoms were partly resolved at the long-term follow-up.

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Figures

Fig. 1
Fig. 1
Pain related outcomes. Changes in outcome variables related to pain before and after corticosteroid injection of the TMJ in 13 patients with JIA. Dotted lines indicate the mean values at each point of time. a changes in pain frequency, b changes in pain intensity, c changes in painindex (frequency x intensity), d Relative pain-scores at different timepoints
Fig. 2
Fig. 2
Outcomes in TMJ mobility. Changes in outcome variables related to TMJ mobility before and after corticosteroid injection of the TMJ in 13 patients with JIA. Dotted lines indicate the mean values at each point of time. a changes in maximal mouth opening, b changes in total laterotrusion, c changes in protrusion
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References

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