Corticosteroid injections in the temporomandibular joint temporarily alleviate pain and improve function in rheumatoid arthritis

Abstract

Objectives: To evaluate the effect of corticosteroid injections in the painful temporomandibular joint (TMJ) of patients with rheumatoid arthritis (RA) in relation to systemic inflammatory activity.

Method: Examination of 35 patients (median age 54 years; 89% female) included maximum mouth opening capacity, degree of anterior open bite (AOB), TMJ pain intensity at rest, and crepitus. Serum levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serotonin, and plasma levels of interleukine-1β (IL-1β) were determined. Out of the 70 examined joints, 53 joints received a corticosteroid (methylprednisolone) injection after the clinical examination at baseline (T0). The examination was repeated for all patients at T1 (median 3.1 weeks after T0), and for 21 patients at T2 (median 6.3 weeks after T1), of whom 20 patients received a second injection at T1.

Results: Maximum mouth opening capacity significantly increased, and TMJ pain intensity significantly decreased between T0 and T1, but these improvements were no longer present at T2. No differences were found in AOB between the time points. Of the joints that received an injection at T0, 19 joints had pretreatment crepitus, which resolved in eight joints at T1. No correlations were found between the change in mouth opening capacity or TMJ pain intensity and ESR, CRP, serotonin, or IL-1β.

Conclusions: Methylprednisolone injections in the TMJ alleviate pain and improve mouth opening capacity for approximately 3 weeks, allowing patients to perform jaw exercises during this timeframe of temporary relief. It thus seems useful for the short-term management of TMJ involvement in RA. Key Points • In rheumatoid arthritis, corticosteroid injection in the temporomandibular joint alleviates pain and improves function. • The clinical improvement achieved with methylprednisolone injections lasts for approximately 3 weeks. • Corticosteroid injections could be used to facilitate and support additional noninvasive, conservative treatment options.

Keywords: Corticosteroid injection; Pain; Rheumatoid arthritis; Temporomandibular joint.

Fig. 1

Maximum mouth opening capacity in 35 patients with rheumatoid arthritis. All patients received a corticosteroid injection in one or both temporomandibular joints (TMJs) at T0, of whom 21 patients had a third visit at T2. The median (IQR) interval was 3.1 (2.1–9.0) weeks between T0 and T1, and 6.3 (4.3–17.9) weeks between T1 and T2. A significant result (p < 0.05) is indicated by an asterisk, while “ns” indicates no statistically significant difference

Fig. 2

Pain intensity at rest in the temporomandibular joint (TMJ) of patients with rheumatoid arthritis. Forty-seven TMJs received a corticosteroid injection at T0, of which for 29 TMJs, data is available during a third visit at T2, while 17 TMJs in the same patient group did not receive corticosteroid injections at T0. The median (IQR) interval was 3.1 (2.1–9.0) weeks between T0 and T1, and 6.3 (4.3–17.9) weeks between T1 and T2. A significant result (p < 0.05) is indicated by an asterisk, while “ns” indicates no statistically significant difference

Fig. 3

Crepitus and fulfillment of the clinical criteria for arthritis in the temporomandibular joint of patients with rheumatoid arthritis. Numbers of transitions between T0 and T1 from crepitus to no crepitus and vice versa (in 68 joints, of which 52 joints received a corticosteroid injection at T0), and from probable clinical arthritis to no clinical arthritis and vice versa (in 64 joints, of which 47 joints received a corticosteroid injection at T0). The median (IQR) interval was 3.1 (2.1–9.0) weeks between T0 and T1