Gregory S Antonarakis1, Delphine S Courvoisier2, Sylviane Hanquinet3, Amira Dhouib4, Raffaella Carlomagno5, Michaël Hofer6, Paolo Scolozzi7. 1. Orthodontist, Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland. Electronic address: gregory.antonarakis@unige.ch. 2. Biostatistician, Division of Oral and Maxillofacial Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland. 3. Professor and Head, Pediatric Radiology Unit, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland. 4. Pediatric Radiologist, Pediatric Radiology Unit, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland. 5. Pediatric Rheumatologist, Unit of Pediatric Rheumatology, University Hospital Center of Vaud, Lausanne, and University Hospital of Geneva, Geneva, Switzerland. 6. Professor and Head, Unit of Pediatric Rheumatology, University Hospital Center of Vaud, Lausanne, and University Hospital of Geneva, Geneva, Switzerland. 7. Professor and Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
Abstract
PURPOSE: The 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). MATERIALS AND METHODS: Forty-one patients (mean age, 13.6 ± 4.0 yr) with juvenile idiopathic arthritis participating in a large prospective juvenile inflammatory rheumatism cohort study (JIRcohorte) were included in this study. Clinical history, examination, and MRI were carried out at baseline and 6 months after intervention, if any. Twenty-one patients underwent lavage and IACS injection in at least 1 TMJ, 8 patients underwent lavage of at least 1 TMJ, and 12 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. RESULTS: All groups showed a mean increase in mouth opening and mean decrease in pain intensity. The mean Helkimo clinical dysfunction score decreased for the 2 intervention groups but not for the control group. The mean Helkimo anamnestic dysfunction score decreased for the lavage with IACS group but not for the lavage-only group. The only statistically relevant difference was found for the Helkimo anamnestic dysfunction score comparing the lavage-only with the 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 at MRI examination. Joints with lavage and ICAS injection showed better improvement than joints that had lavage only or no intervention. CONCLUSION: TMJ lavage with or without IACS injection cannot be claimed to systematically decrease pain, increase mouth opening, or resolve acute inflammation. Despite a tendency for improvement, response to this treatment is very patient dependent and can be determined by an array of other variables.
PURPOSE: The 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). MATERIALS AND METHODS: Forty-one patients (mean age, 13.6 ± 4.0 yr) with juvenile idiopathic arthritis participating in a large prospective juvenile inflammatory rheumatism cohort study (JIRcohorte) were included in this study. Clinical history, examination, and MRI were carried out at baseline and 6 months after intervention, if any. Twenty-one patients underwent lavage and IACS injection in at least 1 TMJ, 8 patients underwent lavage of at least 1 TMJ, and 12 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. RESULTS: All groups showed a mean increase in mouth opening and mean decrease in pain intensity. The mean Helkimo clinical dysfunction score decreased for the 2 intervention groups but not for the control group. The mean Helkimo anamnestic dysfunction score decreased for the lavage with IACS group but not for the lavage-only group. The only statistically relevant difference was found for the Helkimo anamnestic dysfunction score comparing the lavage-only with the 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 at MRI examination. Joints with lavage and ICAS injection showed better improvement than joints that had lavage only or no intervention. CONCLUSION: TMJ lavage with or without IACS injection cannot be claimed to systematically decrease pain, increase mouth opening, or resolve acute inflammation. Despite a tendency for improvement, response to this treatment is very patient dependent and can be determined by an array of other variables.
Authors: Christopher Schmidt; Taila Ertel; Martin Arbogast; Boris Hügle; Thekla von Kalle; Andreas Neff Journal: Dtsch Arztebl Int Date: 2022-01-28 Impact factor: 8.251
Authors: Paula Frid; Thomas A Augdal; Tore A Larheim; Josefine Halbig; Veronika Rypdal; Nils Thomas Songstad; Annika Rosén; Karin B Tylleskär; Johanna Rykke Berstad; Berit Flatø; Peter Stoustrup; Karen Rosendahl; Eva Kirkhus; Ellen Nordal Journal: Pediatr Rheumatol Online J Date: 2020-10-01 Impact factor: 3.054