Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study

Pediatric Rheumatology

Tore A. Larheim¹  Annika Rosén²  Johanna Rykke Berstad³  Paula Frid⁴  Nils Thomas Songstad⁵  Karin B. Tylleskär⁶  Eva Kirkhus⁷  Berit Flatø⁸  Ellen Nordal⁹  Veronika Rypdal⁹  Karen Rosendahl^1,10  Thomas A. Augdal^1,10  Josefine Halbig^1,11  Peter Stoustrup^1,12 

[1] Department of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway;Department of Clinical Dentistry, University of Bergen, Bergen, Norway;Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway;Department of ENT and Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway;Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway;Public Dental Service Competence Centre of North Norway, Tromsø, Norway;Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway;Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway;Department of Pediatrics, Haukeland University Hospital, Bergen, Norway;Department of Radiology, Oslo University Hospital, Oslo, Norway;Department of Rheumatology, Oslo University Hospital, Oslo, Norway;University of Oslo, Oslo, Norway;Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway;Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway;Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway;Section for Pediatric Radiology, Department of Radiology, University Hospital of North Norway, Tromsø, Norway;Public Dental Service Competence Centre of North Norway, Tromsø, Norway;Pediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway;Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark;

关键词: Juvenile idiopathic arthritis;    Temporomandibular joint;    Intraarticular corticosteroids;    Temporomandibular arthritis;    Magnetic resonance imaging;    Efficacy;    Adverse events;   

DOI  :  10.1186/s12969-020-00464-3

来源: Springer

【 摘 要 】

BackgroundIntraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting.MethodsIn this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation.ResultsAmong the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent.ConclusionsIn this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.

【 授权许可】

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