title: Utility of corticosteroid injection for temporomandibular arthritis in children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  To assess the effects of computed tomography (CT)-guided injection of corticosteroid into the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) and clinical and magnetic resonance imaging (MRI) evidence of TMJ inflammation.
  
  
  METHODS
  Twenty-three children ages 4-16 years with JIA and MRI evidence of TMJ inflammation received CT-guided TMJ injections of corticosteroid (triamcinolone acetonide [n = 16] or triamcinolone hexacetonide [n = 7]). Jaw pain or dysfunction and maximal incisal opening (MIO) distance were assessed before and after injection. Fourteen patients had followup MRI studies of the TMJ 6-12 months after injection.
  
  
  RESULTS
  Of the 13 patients with symptoms of jaw pain prior to corticosteroid treatment, 10 (77%) had complete resolution of pain (P < 0.05). Prior to corticosteroid injection, MIO in all 23 patients was below age-matched normal values. After injection, the MIO was improved by at least 0.5 cm in 10 patients (43%) (P = 0.0017). Patients under 6 years of age at the time of injection showed the best response, with a postinjection MIO similar to that in age-matched controls (P = 0.2267). There was involvement of 23 TMJs in the 14 patients who had followup MRI studies; resolution of effusions was observed in 11 (48%) of the TMJs. Other than short-term facial swelling in 2 patients, there were no side effects.
  
  
  CONCLUSIONS
  The majority of children with symptomatic TMJ arthritis improved after intraarticular corticosteroid injection. Approximately half the patients experienced significant improvement in MIO and TMJ effusion. These data suggest that corticosteroid injection may be a useful procedure for the prevention and treatment of morbidities associated with TMJ arthritis in JIA.
authors.affiliation: Center for Childhood Arthritis and Rheumatic Disease, Children's Hospital of Philadelphia, 3405 Civic Center Boulevard, Philadelphia, PA 19104-4399, USA. arabshahi@email.chop.edu
authors.forename: Bita
authors.initials: B
authors.lastname: Arabshahi
authors.forename: Esi Morgan
authors.initials: EM
authors.lastname: Dewitt
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Cahill
authors.forename: Robin D
authors.initials: RD
authors.lastname: Kaye
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Baskin
authors.forename: Richard B
authors.initials: RB
authors.lastname: Towbin
authors.forename: Randy Q
authors.initials: RQ
authors.lastname: Cron
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005157:Facial Pain / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007568:Jaw; D008279:Magnetic Resonance Imaging; D008297:Male; D011795:Surveys and Questionnaires; D013704:Temporomandibular Joint / Q000187:drug effects / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*
chemical_list: D000893:Anti-Inflammatory Agents; D014221:Triamcinolone