title: Quantifying the Effect of Temporomandibular Joint Intra-Articular Steroid Injection on Synovial Enhancement in Juvenile Idiopathic Arthritis.
abstract: OBJECTIVE
  To quantify the effect of intra-articular steroid injections (IASIs) on temporomandibular joint (TMJ) synovitis in children with juvenile idiopathic arthritis (JIA) using gadolinium-enhanced magnetic resonance imaging (MRI).
  
  
  METHODS
  The present study was a retrospective study of children with JIA who had undergone TMJ IASIs at Boston Children's Hospital. The patients were included if they had undergone contrast-enhanced MRI both before and after IASI and if the pre-IASI MRI had demonstrated synovitis (enhancement ratio [ER] >1.55). Patients with TMJ pathology or pain unrelated to JIA or a history of facial trauma were excluded. The predictor variables were age, gender, JIA subtype, exposure to medications for arthritis, and a family history of autoimmune disease. The primary outcome variable was the ER. Additional outcome variables included patient-reported pain and the maximal incisal opening (MIO).
  
  
  RESULTS
  Twenty-nine subjects (83% female) with a total of 50 injected TMJs were included. The average age at JIA diagnosis and at IASI was 6.8 ± 1.7 years and 12.1 ± 1.9 years, respectively. The mean follow-up period was 22.9 ± 4.3 months (range 5 to 48). The ER decreased in all injected joints, with a mean reduction of 1.05 ± 1.01 (P < .001). The post-IASI ER was less than the normal threshold (1.55) in 18% of the injected TMJs. IASI was associated with an elimination of pain in 89% of the subjects (P < .001) and in augmentation of the MIO by 5.8 ± 2.6 mm (P < .001).
  
  
  CONCLUSIONS
  In children with JIA and TMJ synovitis, TMJ IASI was associated with a reduction in synovial enhancement, decreased pain, and an increased MIO. Only 18% of injected joints, however, experienced complete resolution of synovitis. These results support the use of IASI in the management of the pain and dysfunction associated with TMJ synovitis. Further study is required to determine the efficacy of IASI in limiting inflammation and future joint destruction.
authors.affiliation: Attending Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital; Instructor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, MA. Electronic address: cory.resnick@childrens.harvard.edu.
authors.forename: Cory M
authors.initials: CM
authors.lastname: Resnick
authors.affiliation: DMD Candidate, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Pouya M
authors.initials: PM
authors.lastname: Vakilian
authors.affiliation: Visiting Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Walter C. Guralnick Distinguished Professor, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Leonard B
authors.initials: LB
authors.lastname: Kaban
authors.affiliation: Associate Visiting Surgeon, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital; Assistant Professor, Harvard School of Dental Medicine, Boston, MA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Peacock
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000150:complications*; D002648:Child; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium; D006801:Humans; D007270:Injections, Intra-Articular; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D013585:Synovitis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D013704:Temporomandibular Joint / Q000000981:diagnostic imaging*; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D003287:Contrast Media; D005682:Gadolinium; D014222:Triamcinolone Acetonide; C005900:triamcinolone hexacetonide