Quantifying the Effect of TMJ Intra-articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis

Publication date: Available online 5 July 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Pouya M. Vakilian, Leonard B. Kaban, Zachary S. Peacock
PurposeTo quantify the effect of intra-articular steroid injections (IASI) on temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA) using gadolinium enhanced magnetic resonance imaging (MRI).MethodsThis is a retrospective study of children with JIA who underwent TMJ IASIs at Boston Children's Hospital. Patients were included if they had contrast-enhanced MRIs both pre- and post-IASI, and if the pre-IASI MRI demonstrated synovitis (Enhancement Ratio (ER)>1.55). Patients with TMJ pathology or pain unrelated to JIA or a history of facial trauma were excluded. Predictor variables were: age, gender, JIA subtype, exposure to medications for arthritis and family history of autoimmune disease. The primary outcome variable was ER. Additional outcome variables included patient-reported pain and maximal incisal opening (MIO).ResultsTwenty-nine subjects (83% female) with a total of 50 injected TMJs were included. The average ages at JIA diagnosis and at IASI were 6.8±1.7 years and 12.1±1.9 years, respectively. Mean follow-up was 22.9±4.3 months (range 5–48 months). There was a decrease in ER in all injected joints, with a mean reduction of 1.05±1.01 (p<0.001). The post-IASI ER was below the normal threshold (1.55) in 18% of injected TMJs. IASI was associated with elimination of pain in 89% of subjects (p<0.001) and in augmentation of the MIO by 5.8±2.6mm (p<0.001).ConclusionsIn children with JIA and TMJ synovitis, TMJ IASI was associated with reduction in synovial enhancement, decreased pain and increased MIO. Only 18% of injected joints, however, had complete resolution of synovitis. These results support the use of IASI in the management of pain and dysfunction associated with TMJ synovitis. Further study is required to determine the efficacy of IASI in limiting inflammation and future joint destruction.



from OroFacial Medicine via ola Kala on Inoreader http://ift.tt/2a06Svy
via IFTTT

from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/29xoyhE
via IFTTT