title: Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1.
abstract: OBJECTIVE
  Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis.
  
  
  METHODS
  This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3 months. The primary outcome variable was pain at 1 month (by visual analog scale). Secondary outcome variables were pain at 3 months and analgesic consumption. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant.
  
  
  RESULTS
  One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8 years, respectively (P = .02). There was no difference among groups in time to follow-up at 1 month (P = .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P = .12) and 36% for left-side procedures (P = .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P = .01) and 34% for left-side procedures (P = .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P < .01) and 37% for left-side procedures (P < .01). There was no difference in pain decrease among groups (P = .55). There was no difference in the use of narcotic (P = .52) or nonsteroidal anti-inflammatory drugs (P = .71) among groups.
  
  
  CONCLUSIONS
  Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA. Electronic address: gbouloux@hotmail.com.
authors.forename: Gary F
authors.initials: GF
authors.lastname: Bouloux
authors.affiliation: Assistant Professor, Department of Oral and Maxillofacial Surgery, University Buffalo New York, Buffalo, NY; formerly, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jolie
authors.initials: J
authors.lastname: Chou
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Deepak
authors.initials: D
authors.lastname: Krishnan
authors.affiliation: Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Tara
authors.initials: T
authors.lastname: Aghaloo
authors.affiliation: Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA.
authors.forename: Nora
authors.initials: N
authors.lastname: Kahenasa
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR.
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA.
authors.forename: Helen
authors.initials: H
authors.lastname: Giannakopoulos
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018771:Arthralgia / Q000188:drug therapy* / Q000209:etiology; D000069237:Arthrocentesis / Q000009:adverse effects* / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013704:Temporomandibular Joint / Q000601:surgery
chemical_list: D000305:Adrenal Cortex Hormones; D006820:Hyaluronic Acid