title: Temporomandibular joint steroid injections in patients with juvenile idiopathic arthritis: an observational pilot study on the long-term effect on signs and symptoms.
abstract: BACKGROUND
  Temporomandibular joint (TMJ) inflammation in patients with juvenile idiopathic arthritis (JIA) can lead to orofacial pain and malfunction of the TMJ. Intra-articular corticosteroid injections (IACI) have been suggested as a treatment modality against TMJ arthritis-related orofacial signs and symptoms. However, knowledge of the effect-durability of these injections remains unanswered. The aim of this pilot study was to evaluate the short and long-term effects of IACI on orofacial symptoms in a prospective observational study based on pre-specified clinical examination standards.
  
  
  METHODS
  Thirteen patients with JIA and arthritis-related orofacial signs and symptoms were included in this prospective pilot study (median 17.2 years, IQR 15-18.4 years). All patients received TMJ IACI (11 bilateral and two unilateral) due to an insufficient response to previous pain-management treatments. Three standardized clinical examinations were carried out: T1 prior to treatment, T2 short-term follow-up (mean 34 days post-treatment), T3 long-term follow-up (mean 333 days post-treatment).
  
  
  RESULTS
  Significant pain reduction was observed at the short-term follow-up (T2). Resolution of orofacial pain after IACI was a rare finding at T2. Generally, the pain significantly worsened between T2 and T3 examinations. The reported pain levels rose between T2 and T3 indicating a loss of effect of the IACI at the long-term follow-up examination (T3). Non-significant improvements in TMJ mobility were observed at T2 and T3.
  
  
  CONCLUSIONS
  Our results suggest a palliative (not curative) effect of IACI for TMJ arthritis-related orofacial symptoms in patients with long-term orofacial pain complaints. The short-term improvements in signs and symptoms were partly resolved at the long-term follow-up.
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. pstoustrup@odont.au.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Stoustrup
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. KDKI@odont.au.dk.|Specialist Oral Health Center for Western Norway, Stavanger, Rogaland, Norway. KDKI@odont.au.dk.
authors.forename: Kasper Dahl
authors.initials: KD
authors.lastname: Kristensen
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. annekuse@rm.dk.|Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark. annekuse@rm.dk.
authors.forename: Annelise
authors.initials: A
authors.lastname: Küseler
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, DK-8000, Aarhus C, Denmark. thompede@rm.dk.|Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark. thompede@rm.dk.
authors.forename: Thomas Klit
authors.initials: TK
authors.lastname: Pedersen
authors.affiliation: Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus N, Denmark. troeherl@rm.dk.
authors.forename: Troels
authors.initials: T
authors.lastname: Herlin
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D010147:Pain Measurement; D010865:Pilot Projects; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents