Is there a difference with intraarticular injections of corticosteroids, hyaluranate or placebo for temporomandibular osteoarthritis

Publication date: Available online 8 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yan Liu, Jiashun Wu, Wei Fei, Xiao Cen, Yi Xiong, Shasha Wang, Yaling Tang, Xinhua Liang
PurposeCorticosteroids are widely used for treatment of temporomandibular joint (TMJ) osteoarthritis. The purpose of this study is to investigate the effects of corticosteroids on TMJ osteoarthritis compared to placebo or hyaluronate.MethodsThe investigators designed and implemented a systematic review and meta-analysis to compare the effects of an intra-articular injection of a corticosteroid, hyaluronate, or placebo for TMJ osteoarthritis patients. We searched related randomized controlled studies electronically in multiple English- and Chinese-language electronic databases. The predictor variable was intra-articular injection with corticosteroid, hyaluronate or placebo. The primary outcome variables were pain intensity, and maximal mouth opening. Other variables included success rate and adverse events. Meta-analyses were performed with Rev Man 5.3.ResultsEight studies met the inclusion criteria. The meta-analysis revealed that corticosteroid injections after arthrocentesis were superior to placebo in relieving pain assessed with VAS (MD -0.74, 95%CI -1.34 to -0.13; P=0.02, I²=0%) in long-term effect, but was inferior in increasing maximal mouth opening (MD -2.06, 95%CI -2.76 to -1.36; P<0.00001, I²=28%). Although both corticosteroid and hyaluronate injections without arthrocentesis reduced pain and improved maximal mouth opening, the corticosteroid group had a significantly lower success rate (OR 0.41, 95%CI 0.17 to 1.00; P=0.05, I²=0%) than hyaluronate group in the short-term effect.ConclusionCorticosteroid injections after arthrocentesis were recommended to be taken for TMJ osteoarthritis patients to relieve joint pain rather than increase maximal mouth opening. Both corticosteroid and hyaluronate have a great effectiveness on TMJ osteoarthritis; however, hyaluronate might be the better alternative to some extent.



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