Temporomandibular joint (TMJ) involvement is seen in patients with juvenile idiopathic arthritis (JIA). Interventions for TMJ arthritis in these patients are aimed at maintaining joint function and reducing symptoms and avoiding permanent damage to the joint components. Treatment of the TMJ has included intra- articular corticosteroid injection (IACI). However there are concerns that while there are short-term benefits there may be long term effects on mandibular growth. The aim of this review was to examine the efficacy and safety of intra-articular steroid injection use in juvenile idiopathic arthritis patients with temporomandibular joint arthritis.
The Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science Cochrane database of systematic reviews, LILACS , Scopus, Google Scholar and Clinical Trials.gov databases were searched. Meta-analysis, randomized clinical trials (RCT), cohort studies, observational studies, case series (prospective/retrospective) with outcome variables evaluating the clinical and/or radiological effect of intra-articular corticosteroid administration against TMJ arthritis in patients with JIA were included. Studies were assessed for risk of bias. Two reviewers assessed studies independently.
- Seven studies were included, only one was prospective the rest being retrospective. All were assessed as at high risk of bias.
- The current limited level of evidence suggests potential beneficial properties of IACI in patients with TMJ arthritis-related symptoms and/or MRI-verified signs of TMJ inflammation. Currently, no scientific evidence substantiates the effect of IACI in terms of (I) improving maximal mouth opening capacity significantly, (II) reducing radiological disease progression, (III) normalising/improving mandibular growth, and (IV) increasing efficacy upon repeated injections.
The authors concluded
The current level of evidence allows only very limited conclusions on the effect of IACI therapy in patients with TMJ arthritis. Knowledge on the long-term impact of IACI on mandibular growth is not available. Future studies designed in accordance with evidence-based standards are needed to allow a more general conclusion on efficacy and safety of this treatment modality in patients with TMJ arthritis.
Stoustrup P, Kristensen KD, Verna C, Küseler A, Pedersen TK, Herlin T. Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety. Semin Arthritis Rheum. 2013 Jan 24. doi:pii: S0049-0172(12)00269-7. 10.1016/j.semarthrit.2012.11.003. [Epub ahead of print] PubMed PMID: 23352251.