title: Safety and efficacy of intra-articular infliximab therapy for treatment-resistant temporomandibular joint arthritis in children: a retrospective study.
abstract: OBJECTIVE
  TM joint (TMJ) arthritis occurs in up to 80% of children with JIA and can result in substantial deformity. TMJ arthritis can be refractory to systemic immunosuppressive therapy and IA CS injections (IACIs). Multiple studies have shown the benefit of IA infliximab injections (IAIIs) in several different joints, so we used intra-articular infliximab injections (IAIIs) in JIA patients with TMJ arthritis refractory to IACIs. The objective of the study was to test the safety and efficacy of IAII therapy for TMJ arthritis.
  
  
  METHODS
  Retrospective chart review was performed for all children with JIA treated at a single centre who received one or more IAIIs. Outcomes assessed were safety of the injections as well as efficacy as evidenced by maximal incisal opening (MIO) and MRI findings.
  
  
  RESULTS
  Twenty-four children underwent bilateral IAIIs, all of whom had at least one follow-up visit after the final injection. All 24 tolerated the injections without any adverse events. MIOs were unchanged in patients before and after IAII. Findings of acute synovitis were present in 30/46 (65%) TMJs at baseline, 44/48 (92%) following completion of the IACI and 42/48 (88%) following completion of the IAII; findings of chronic synovitis at the three time points were 12/46 (26%), 29/48 (60%) and 38/48 (79%). Resolution of the arthritis was observed in six TMJs.
  
  
  CONCLUSIONS
  IAII was safe and it reversed the progression of TMJ arthritis in some patients with refractory disease. Future studies will evaluate the efficacy of infliximab vs CS injections as initial therapy for TMJ arthritis.
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South/Suite 210 N, Birmingham, AL 35233-1711, USA. mstoll@peds.uab.edu
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Stoll
authors.forename: Anthony B P
authors.initials: AB
authors.lastname: Morlandt
authors.forename: Suwat
authors.initials: S
authors.lastname: Teerawattanapong
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: D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D000069285:Infliximab; D007270:Injections, Intra-Articular; D008297:Male; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab