title: Intra-articular corticosteroid injections to the temporomandibular joints are safe and appear to be effective therapy in children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the safety and efficacy of intra-articular corticosteroid injections (IACIs) of the temporomandibular joint (TMJ) in children with juvenile idiopathic arthritis (JIA) when administered by an oral and maxillofacial surgeon without imaging guidance.
  
  
  METHODS
  This was a retrospective study of children with JIA, seen at a single center, who were selected based on having received IACIs of the TMJ. All subjects received the intervention, which consisted of referral to a single oral and maxillofacial surgeon for TMJ IACI with 5 to 10 mg triamcinolone hexacetonide, under general anesthesia. Primary outcomes assessed in all subjects were the safety of the procedure and efficacy as determined by the change in maximal incisal opening (MIO). In addition, a subset of 31 subjects underwent repeat magnetic resonance imaging of the TMJ, permitting analysis of the change in the acute and chronic findings of arthritis in those patients.
  
  
  RESULTS
  Sixty-three patients (68% female) received 137 IACIs. The mean age for diagnosis of JIA was 8.5 years, and the mean age at presentation for TMJ injections was 10 years. The injections were well tolerated: only 1 patient developed the steroid complication of hypopigmentation, and none developed degeneration or ankylosis. In terms of efficacy, the mean MIO increased from 40.8 ± 0.93 to 43.5 ± 0.90 mm (P = .001); in addition, changing the unit of analysis to individual joints, in patients who underwent repeat magnetic resonance imaging examination, 51% of TMJs showed magnetic resonance imaging evidence of improvement of arthritic changes, of whom 18% had complete resolution of TMJ arthritis.
  
  
  CONCLUSIONS
  The results indicate that IACI of the TMJ can be safely performed by experienced oral and maxillofacial surgeons without a requirement for computed tomographic guidance. In addition, these results show that IACI may be effective in the management of TMJ arthritis, although further studies are required.
authors.affiliation: Department of Pediatrics, Division of Rheumatology, Children's Hospital of Alabama, Birmingham, AL 35233, USA. mstoll@peds.uab.edu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Stoll
authors.forename: Jennifer
authors.initials: J
authors.lastname: Good
authors.forename: Tyler
authors.initials: T
authors.lastname: Sharpe
authors.forename: Timothy
authors.initials: T
authors.lastname: Beukelman
authors.forename: Daniel
authors.initials: D
authors.lastname: Young
authors.forename: Peter D
authors.initials: PD
authors.lastname: Waite
authors.forename: Randy Q
authors.initials: RQ
authors.lastname: Cron
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D008335:Mandibular Condyle / Q000187:drug effects / Q000473:pathology; D016059:Range of Motion, Articular / Q000187:drug effects; D012189:Retrospective Studies; D012449:Safety; D013515:Surgery, Oral; D013582:Synovial Fluid / Q000187:drug effects; D013704:Temporomandibular Joint / Q000187:drug effects / Q000473:pathology; D019224:Temporomandibular Joint Disc / Q000187:drug effects / Q000473:pathology; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D003287:Contrast Media; D005938:Glucocorticoids; D005682:Gadolinium; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide