Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety.
OBJECTIVE
To determine the current level of evidence for the use of intra-articular corticosteroid injections (IACI) against temporomandibular joint (TMJ) arthritis in patients with juvenile idiopathic arthritis (JIA) with a particular focus on clinical and radiological improvements and safety profile.


METHODS
A comprehensive electronic search strategy was performed in all major medical databases in February 2012. Studies were selected independently by two reviewers in accordance with a pre-specified protocol and a risk of bias assessment for all included studies.


RESULTS
Ninety-four unique citations were identified of which seven remained after the inclusion criteria were applied and all of these were assessed to have a high risk of bias. The current limited level of evidence suggests potential beneficial properties of IACI in patients with TMJ arthritis-related symptoms and/or MRI-verified signs of TMJ inflammation. Currently, no scientific evidence substantiates the effect of IACI in terms of (I) improving maximal mouth opening capacity significantly, (II) reducing radiological disease progression, (III) normalising/improving mandibular growth, and (IV) increasing efficacy upon repeated injections.


CONCLUSIONS
The current level of evidence allows only very limited conclusions on the effect of IACI therapy in patients with TMJ arthritis. Knowledge on the long-term impact of IACI on mandibular growth is not available. Future studies designed in accordance with evidence-based standards are needed to allow a more general conclusion on efficacy and safety of this treatment modality in patients with TMJ arthritis.
Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C, Denmark. pstoustrup@odont.au.dk
Peter
P
Stoustrup
Kasper D
KD
Kristensen
Carlalberta
C
Verna
Annelise
A
Küseler
Thomas K
TK
Pedersen
Troels
T
Herlin
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy*; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects*; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents
Arthritis; Intra-articular; Juvenile idiopathic arthritis; Steroid; Systematic review; Temporomandibular joint