title: Magnetic Resonance Imaging Assessment of Temporomandibular Joint Involvement and Mandibular Growth Following Corticosteroid Injection in Juvenile Idiopathic Arthritis.
abstract: OBJECTIVE
  To assess whether intraarticular corticosteroid injection (CSI) reduces inflammation of the temporomandibular joint (TMJ), prevents growth disturbances of the mandibular condyle, and restores normal growth of the mandibular ramus.
  
  
  METHODS
  Retrospective longitudinal magnetic resonance imaging (MRI) evaluation of inflammatory activity, TMJ deformity, and mandibular ramus height in 33 children (23 girls, median age 5.2 yrs) over a median period of 5 years following repetitive CSI to the TMJ.
  
  
  RESULTS
  Intraarticular location of CSI led to inflammatory grade improvement in 53% at first MRI followup compared to 20% with extraarticular location (p = 0.005), with more improvement of the mean inflammatory grade after intraarticular CSI (p = 0.001). Rate of osseous deformities of the TMJ deteriorated from 51% at study inclusion to 62% at end of observation period, with progression to severe condylar destruction in 26% of joints including 24% with development of intraarticular calcifications/ossifications. Mean short-term growth rates of the mandibular ramus were negative for intraarticular CSI while positive for extraarticular CSI (p = 0.036). Mean longterm mandibular ramus growth rate (0.7 ± 0.8 mm/yr) after CSI was significantly lower than reported normal mean age- and sex-matched growth rate (1.4 ± 0.1 mm/yr, p < 0.0001).
  
  
  CONCLUSIONS
  Despite improving the inflammatory activity as seen on MRI, repetitive CSI to the TMJ does not reach the treatment goals to prevent progressive osseous deformation and to normalize mandibular ramus growth in children with juvenile idiopathic arthritis.
authors.affiliation: From the Department of Diagnostic Imaging, and Children's Research Center, and Division of Rheumatology, University Children's Hospital; Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland.N. Lochbühler, MD, pediatric radiology fellow, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital; R.K. Saurenmann, MD, PD (Privatdozent), pediatric rheumatologist, department head, Children's Research Center, and Division of Rheumatology, University Children's Hospital; L. Müller, DDS, orthodontist, Clinic for Orthodontics and Pediatric Dentistry; C.J. Kellenberger, MD, PD (Privatdozent), pediatric radiologist, department head, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital.
authors.forename: Nina
authors.initials: N
authors.lastname: Lochbühler
authors.affiliation: From the Department of Diagnostic Imaging, and Children's Research Center, and Division of Rheumatology, University Children's Hospital; Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland.N. Lochbühler, MD, pediatric radiology fellow, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital; R.K. Saurenmann, MD, PD (Privatdozent), pediatric rheumatologist, department head, Children's Research Center, and Division of Rheumatology, University Children's Hospital; L. Müller, DDS, orthodontist, Clinic for Orthodontics and Pediatric Dentistry; C.J. Kellenberger, MD, PD (Privatdozent), pediatric radiologist, department head, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital.
authors.forename: Rotraud Katharina
authors.initials: RK
authors.lastname: Saurenmann
authors.affiliation: From the Department of Diagnostic Imaging, and Children's Research Center, and Division of Rheumatology, University Children's Hospital; Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland.N. Lochbühler, MD, pediatric radiology fellow, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital; R.K. Saurenmann, MD, PD (Privatdozent), pediatric rheumatologist, department head, Children's Research Center, and Division of Rheumatology, University Children's Hospital; L. Müller, DDS, orthodontist, Clinic for Orthodontics and Pediatric Dentistry; C.J. Kellenberger, MD, PD (Privatdozent), pediatric radiologist, department head, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital.
authors.forename: Lukas
authors.initials: L
authors.lastname: Müller
authors.affiliation: From the Department of Diagnostic Imaging, and Children's Research Center, and Division of Rheumatology, University Children's Hospital; Clinic for Orthodontics and Pediatric Dentistry, University of Zürich, Zürich, Switzerland.N. Lochbühler, MD, pediatric radiology fellow, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital; R.K. Saurenmann, MD, PD (Privatdozent), pediatric rheumatologist, department head, Children's Research Center, and Division of Rheumatology, University Children's Hospital; L. Müller, DDS, orthodontist, Clinic for Orthodontics and Pediatric Dentistry; C.J. Kellenberger, MD, PD (Privatdozent), pediatric radiologist, department head, Department of Diagnostic Imaging, and Children's Research Center, University Children's Hospital. christian.kellenberger@kispi.uzh.ch.
authors.forename: Christian Johannes
authors.initials: CJ
authors.lastname: Kellenberger
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D008279:Magnetic Resonance Imaging; D008297:Male; D008335:Mandibular Condyle / Q000254:growth & development*; D012189:Retrospective Studies; D013704:Temporomandibular Joint / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones
keywords: INTRAARTICULAR INJECTIONS; JUVENILE IDIOPATHIC ARTHRITIS; MAGNETIC RESONANCE IMAGING; STEROIDS; TEMPOROMANDIBULAR JOINT