Steroid injection effective for TMJ arthritis

By Will Boggs, MD

NEW YORK (Reuters Health) – Temporomandibular joint (TMJ)
arthritis in patients with juvenile arthritis can be relieved
with corticosteroid injection, investigators report.

Many TMJ-related symptoms are caused by the effects of
physical and emotional stress on the structures around the
joint, including the muscles of the jaw, face and neck. Along
with arthritis, other symptoms may include popping sounds in
the jaw, inability to fully open the mouth, headaches and other
types of facial pain.

“TMJ arthritis can be active even when children are being
treated with methotrexate and tumor necrosis factor inhibitors,
so corticosteroid injection should be strongly considered when
TMJ arthritis is diagnosed in children with chronic arthritis,”
Dr. Randy Q. Cron told Reuters Health.

Cron from Children’s Hospital of Philadelphia, Pennsylvania
and colleagues investigated the safety and effectiveness of TMJ
corticosteroid injections in 23 children between 4 and 16 years
old with juvenile idiopathic arthritis.

“TMJ arthritis is very common and often asymptomatic,” Cron
pointed out. “If you do not screen for it by MRI (the current
gold standard and most sensitive modality), you will likely
miss it.”

Ten of 13 children with jaw pain before treatment
experienced complete resolution of pain with chewing and jaw
exertion after the corticosteroid injection, the team reports
in the journal Arthritis & Rheumatism. Corticosteroid injection
also improved jaw locking in two of the three children who had

Maximal opening of the jaw increased by at least 0.5
centimeter in 43 percent of the children after corticosteroid
injection, the report indicates, with younger patients showing
the best response.

TMJ-related swelling resolved in 48 percent of children,
the researchers note, but there were no significant changes in
bone abnormalities.

Corticosteroid injection resulted in short-term facial
swelling in two patients, the results indicate, but no skin
inflammation, infection or atrophy beneath the skin occurred.

“We are currently screening children with chronic arthritis
at disease onset for TMJ arthritis,” Cron said. “We are also
trying to find markers that predict TMJ arthritis. Although
preliminary, our results suggest that most all children have
evidence of TMJ arthritis at disease onset.”

Cron recommends treating these children “as early as
possible” — as soon as it is detected.

SOURCE: Arthritis and Rheumatism, November 2005.

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