Non CT-guided intra-articular steroid treatment of active temporomandibular involvement in juvenile idiopathic arthritis

Background: Temporomandibular joint (TMJ) involvement is an insidious and threatening complication of Juvenile Idiopathic Arthritis (JIA). Intrarticular corticosteroid injection (IACS) are used as first line therapy for persistent oligoarthritis and have been found to be effective in all joints, included the small ones. Objectives: Purpose of our study was to evaluate the safety and efficacy of IACS treatment in children with JIA and temporo-mandibular joint (TMJ) involvement by using a non-Computer tomography (CT) guided procedure. Methods: 11 JIA patients, aged 5-18 years, with evidence of active TMJ involvement received 0,5 mgkg of triamcinolone acetonide monolaterally (8) or bilaterally (3), according with MRI images. Clinical symptoms (jaw pain at rest and at maximal mouth opening, morning stiffness, TMJ noises) and signs (jaw deviation on opening and limitation in function) were assessed at baseline and 3, 6, and 12 months after treatment. Results: At 12 months follow up, the treatment was clinically successful in 9/11 patients. Six out of 7 patients with symptoms prior IACS, had complete resolution. 4/8 children with deviation of mouth opening, improved. Among 4 patients with function limitation, 3 had complete resolution at 2 months but, unfortunately, 1 relapsed at 6 months and another at 12 months. The only patient refractory to IACS treatment was the oldest one (18 years) with 11 years disease duration. The treatment was well tolerated in all patients. A slight subcutaneous atrophy was observed in one patient, 6 months after injection. Conclusion: IACS treatment of active TMJ arthritis is safe and effective in JIA although efficacy seems to decrease after 12 months follow-up. We suggest to perform this treatment as early as possible, at the first MRI evidence of arthritis, and find no need for a CT-guided procedure.