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22-04-2012 | Immunology | Article

TMJ injection relieves juvenile arthritis jaw ache

Abstract

Free abstract

MedWire News: Intra-articular corticosteroid (CS) injection to the temporomandibular joint (TMJ) is an effective and well-tolerated treatment, suggests a study of patients with juvenile idiopathic arthritis (JIA).

The research, published in Rheumatology, showed that TMJ injection resolved pain and achieved significant improvements in function.

Athimalaipet Ramanan (Bristol Royal Hospital for Children, UK) and co-authors explain that active TMJ arthritis is common even in children with a new diagnosis of JIA. Symptoms include pain on jaw movement, and difficulties chewing and opening the mouth.

They investigated the efficacy and safety of ultrasound-guided CS injections by a pediatric rheumatologist into 63 joints of 38 children with JIA between January 2009 and January 2011. Triamcinolone hexacetonide was given under general anesthetic at a weight-dependent dose of 10-20 mg/mL. The patients were aged an average of 12.25 years and the mean duration of JIA diagnosis was 4.54 years.

Before treatment, 44.7% of the children had pain, 36.8% had jaw deviation, 34.2% had restricted jaw movement, 18.4% had a chewing dysfunction, and 12.5% had micrognathia.

Overall, 92.06% of joints responded to treatment, including 93.3% of patients with a single TMJ treated and 91.6% of patients who were treated on both sides. Pain, tenderness, and stiffness resolved in all children affected, and jaw deviation improved in 92.8% of affected patients. Chewing dysfunction improved in 71.4% of patients with this symptom.

Five injections were not effective; four treatments were given to two children who had TMJ infection in both sides and continued to have stiffness. One injection failed to improve jaw deviation in a third child.

One patient experienced scarring at the injection site, the researchers note.

"In our experience, the high success rate with minimal side effects emphasizes the potential utility of this procedure," Ramanan et al conclude.

"Training of paediatric rheumatologists in the technique could be valuable, and it may be potentially useful to draw attention to this in the training curriculum."

By Lynda Williams

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