Effectiveness of dexamethasone iontophoresis for temporomandibular joint involvement in juvenile idiopathic arthritis.
OBJECTIVE
Temporomandibular joint (TMJ) involvement is common in juvenile idiopathic arthritis (JIA). Dexamethasone iontophoresis (DIP) uses low-grade electric currents for transdermal dexamethasone delivery into deeper anatomic structures. The purpose of this study was to assess the safety and effectiveness of DIP for the treatment of TMJ involvement in JIA, and to delineate variables that are associated with improvement after DIP.


METHODS
Medical records of all JIA patients who underwent DIP for TMJ involvement at a larger tertiary pediatric rheumatology center from 1997-2011 were reviewed. DIP was performed using a standard protocol. The effectiveness of DIP was assessed by comparing the maximal interincisor opening (MIO(TMJ) ) and the maximal lateral excursion (MLE(TMJ) ) before and after treatment.


RESULTS
Twenty-eight patients (ages 2-21 years) who received an average of 8 DIP treatment sessions per involved TMJ were included in the analysis. Statistically significant improvement in the median MIO(TMJ)  (P < 0.0001) was observed in 68%. The median MLE(TMJ)  (P = 0.03) improved in 69%, and resolution of TMJ pain occurred in 73% of the patients who had TMJ pain at baseline. Side effects of DIP were transient site erythema (86%), skin blister (4%), and metallic taste (4%). Improvement in TMJ range of motion from DIP is associated with lower MIO(TMJ) , lower MLE(TMJ) , and absence of TMJ crepitus at baseline.


CONCLUSIONS
In this pilot study, DIP appeared to be an effective and safe initial treatment of TMJ involvement in JIA, especially among patients with decreased TMJ measurements. Prospective controlled studies are needed.
Cincinnati Children's Hospital Medical Center, Ohio 45229-3039, USA. minara@ucmail.uc.edu
Rina
R
Mina
Paula
P
Melson
Stephanie
S
Powell
Marepalli
M
Rao
Claas
C
Hinze
Murray
M
Passo
T Brent
TB
Graham
Hermine I
HI
Brunner
D000279:Administration, Cutaneous; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018771:Arthralgia / Q000188:drug therapy / Q000503:physiopathology; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001696:Biomechanical Phenomena; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D005157:Facial Pain / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006776:Hospitals, Pediatric; D006801:Humans; D007478:Iontophoresis / Q000009:adverse effects; D008297:Male; D009820:Ohio; D010147:Pain Measurement; D010865:Pilot Projects; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000187:drug effects* / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D003907:Dexamethasone