Benefit of temporomandibular joint lavage with intra-articular steroids versus lavage alone in the management of temporomandibular joint involvement in juvenile idiopathic arthritis

Publication date: Available online 8 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): S. Antonarakis Gregory, S. Courvoisier Delphine, Hanquinet Sylviane, Dhouib Amira, Carlomagno Raffaella, Hofer Michaël, Scolozzi Paolo
PurposeThe aim of the present investigation was to evaluate, in patients with juvenile idiopathic arthritis, the effect of lavage with or without intra-articular corticosteroid (IACS) injection, on clinical temporomandibular joint (TMJ) signs and symptoms of inflammation, and changes in acute inflammation as assessed using magnetic resonance imaging (MRI).MethodsA total of 41 patients with juvenile idiopathic arthritis participating in a large prospective juvenile inflammatory rheumatism cohort study (JIRcohorte) were included with a mean age of 13.6 +/- 4.0 years. Clinical history, examination and MRI were carried out at baseline and six months following intervention, if any. Twenty-one patients underwent lavage and IACS injection in at least one TMJ, eight patients underwent lavage of at least one TMJ, and twelve patients were followed with no intervention. Outcomes measured were maximal mouth opening, Helkimo dysfunction index scores, pain intensity, and acute inflammation as assessed using MRI.ResultsAll groups showed a mean increase in mouth opening and mean decrease in pain intensity. The mean Helkimo clinical dysfunction score decreased for both intervention groups but not the control group. The mean Helkimo anamnestic dysfunction score decreased for the lavage with IACS group but not the lavage only group. The only statistically significant difference was found for Helkimo anamnestic dysfunction comparing the lavage to lavage with IACS group with a more positive effect found in the lavage with IACS group. More than 50% of joints in each group showed no change in the MRI examination. Joints with lavage and ICAS injection showed better improvement than joints that had lavage only or no intervention.ConclusionTMJ lavage with or without IACS cannot be claimed to systematically reduce pain, increase mouth opening, or resolve acute inflammation. Despite a tendency for improvement, response to this treatment is very patient dependent, and may be determined by an array of other variables.



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