Yan Liu1, Jiashun Wu2, Wei Fei3, Xiao Cen4, Yi Xiong5, Shasha Wang6, Yaling Tang7, Xinhua Liang8. 1. Resident, Department of Oral and Maxillofacial Surgery and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 2. Resident, Department of Oral Pathology and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 3. Professor, Department of Stomatology, Sichuan Medical Science Academy and Sichuan Provincial People's Hospital, Sichuan, China. 4. Predoctoral Student, Department of Oral and Maxillofacial Surgery and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 5. Predoctoral Student, Department of Implantology and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 6. Postgraduate Student, Department of Oral and Maxillofacial Surgery and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 7. Professor, Department of Oral Pathology and State Key Laboratory of Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. 8. Professor, Department of Oral and Maxillofacial Surgery, State Key Laboratory of Oral Diseases, and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology (Sichuan University), Sichuan, China. Electronic address: lxh88866@scu.edu.cn.
Abstract
PURPOSE: Corticosteroids are widely used for treatment of temporomandibular joint (TMJ) osteoarthritis (OA). This study investigated the effects of corticosteroids on TMJOA compared with placebo or hyaluronate. MATERIALS AND METHODS: The authors designed and implemented a systematic review and meta-analysis to compare the effects of intra-articular injection of corticosteroid, hyaluronate, or placebo for patients with TMJOA. The authors 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. 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. RESULTS: Eight studies met the inclusion criteria. Meta-analysis showed that corticosteroid injections after arthrocentesis were superior to placebo in relieving pain as assessed with the visual analog scale (mean difference [MD], -0.74; 95% confidence interval [CI], -1.34 to -0.13; P = .02; I2 = 0%) in the long-term, but was inferior in increasing maximal mouth opening (MD, -2.06; 95% CI, -2.76 to -1.36; P < .00001; I2 = 28%). Although corticosteroid and hyaluronate injections without arthrocentesis decreased pain and improved maximal mouth opening, the corticosteroid group had a significantly lower success rate (odds ratio = 0.41; 95% CI, 0.17-1.00; P = .05; I2 = 0%) than the hyaluronate group in the short term. CONCLUSION: Corticosteroid injections after arthrocentesis are recommended for patients with TMJOA to relieve joint pain rather than increase maximal mouth opening. Corticosteroid and hyaluronate have marked effectiveness on TMJOA; however, hyaluronate might be the better alternative to some extent.
PURPOSE: Corticosteroids are widely used for treatment of temporomandibular joint (TMJ) osteoarthritis (OA). This study investigated the effects of corticosteroids on TMJOA compared with placebo or hyaluronate. MATERIALS AND METHODS: The authors designed and implemented a systematic review and meta-analysis to compare the effects of intra-articular injection of corticosteroid, hyaluronate, or placebo for patients with TMJOA. The authors 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. 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. RESULTS: Eight studies met the inclusion criteria. Meta-analysis showed that corticosteroid injections after arthrocentesis were superior to placebo in relieving pain as assessed with the visual analog scale (mean difference [MD], -0.74; 95% confidence interval [CI], -1.34 to -0.13; P = .02; I2 = 0%) in the long-term, but was inferior in increasing maximal mouth opening (MD, -2.06; 95% CI, -2.76 to -1.36; P < .00001; I2 = 28%). Although corticosteroid and hyaluronate injections without arthrocentesis decreased pain and improved maximal mouth opening, the corticosteroid group had a significantly lower success rate (odds ratio = 0.41; 95% CI, 0.17-1.00; P = .05; I2 = 0%) than the hyaluronate group in the short term. CONCLUSION: Corticosteroid injections after arthrocentesis are recommended for patients with TMJOA to relieve joint pain rather than increase maximal mouth opening. Corticosteroid and hyaluronate have marked effectiveness on TMJOA; however, hyaluronate might be the better alternative to some extent.
Authors: Salvador Israel Macías-Hernández; Juan Daniel Morones-Alba; Irene Tapia-Ferrusco; Oscar Benjamín Vélez-Gutiérrez; Cristina Hernández-Diaz; Tania Inés Nava-Bringas; Eva Cruz-Medina; Lya Contreras-Del Toro; Ma de Los Angeles Soria-Bastida Journal: J Korean Assoc Oral Maxillofac Surg Date: 2022-02-28