Abstract
Objective
To describe the clinical and radiographic outcomes in a series of patients with juvenile idiopathic arthritis (JIA) who underwent one or more intraarticular corticosteroid (IAS) injections of the temporomandibular joint (TMJ) performed without imaging guidance.
Methods
Retrospective chart review was performed for all patients with JIA diagnosed and treated at our institution between January 1, 2000, and January 1, 2006, who underwent one or more IAS injections of their TMJ. IAS injections were performed by the same oral and maxillofacial surgeon without imaging guidance, using either triamcinolone acetonide or triamcinolone hexacetonide. The primary outcomes assessed were maximal incisal opening (MIO) measurements, patient-reported symptoms, physical examination findings, and imaging results.
Results
Twenty-five patients were identified. Twenty-one (84%) had radiographic evidence of TMJ disease when TMJ disease was first suspected by their physician. The 25 patients underwent 74 IAS injections on 47 separate occasions. When baseline MIO measurements were compared to the last MIO measurements of the study period, there was a mean increase in MIO of 6.9 mm (p = 0.002; 95% CI 3, 10.7). There was a mean increase in MIO of 3.8 mm following each IAS injection (p = 0.003; 95% CI 1.4, 6.2). Patients who underwent multiple IAS injections had a mean increase in MIO after first injection of 6.6 mm (p < 0.001; 95% CI 4.1, 9.1); however, the mean increase in MIO after subsequent injections was 0.4 mm (p = 0.8; 95% CI −3.5, 4.4). One patient developed subcutaneous atrophy at the injection site. Two patients developed small, asymptomatic intraarticular calcifications. No additional adverse events were reported.
Conclusion
In this patient population, there was an overall increase in MIO measurements following initial IAS injection and during the study period. Patients tended to have minimal response to subsequent injections. IAS injections performed without imaging guidance by an experienced oral and maxillofacial surgeon were well tolerated with only rare adverse events. The presence of radiographic changes when the physician first suspected TMJ disease in 84% of patients emphasizes the need for better screening and early intervention for synovitis in this joint.
Key Indexing Terms:Footnotes
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S. Ringold, MD, Fellow; T.R. Torgerson, MD, PhD, Assistant Professor of Pediatrics, Division of Immunology, Rheumatology and Infectious Disease, Department of Pediatrics, University of Washington and Children’s Hospital and Regional Medical Center; M.A. Egbert, DDS, Associate Professor, Chief, Division of Pediatric Oral and Maxillofacial Surgery, Department of Pediatric Dental Medicine, Children’s Hospital and Regional Medical Center; C.A. Wallace, MD, Associate Professor of Pediatrics, Division of Immunology, Rheumatology and Infectious Disease, Department of Pediatrics, University of Washington and Children’s Hospital and Regional Medical Center; Vice Chair, Childhood Arthritis and Rheumatology Research Alliance (CARRA); Advisory Council, Pediatric Rheumatology Collaborative Study Group (PRCSG), Children’s Hospital and Regional Medical Center, Seattle, WA.
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Supported by The Axtell-Steffes Foundation.
- Accepted for publication January 28, 2008.
