Magnetic Resonance Imaging Assessment of Temporomandibular Joint Involvement and Mandibular Growth Following Corticosteroid Injection in Juvenile Idiopathic Arthritis

Abstract

Despite improving the inflammatory activity as seen on MRI, repetitive CSI to the TMJ does not reach the treatment goals to prevent progressive osseous deformation and to normalize mandibular ramus growth in children with juvenile idiopathic arthritis.

Silent Joint in Dispute. Is Intraarticular Treatment of Temporomandibular Joint Questionable?

“…Although the findings in experimental arthritis could not be directly applied to humans, the results showed an urgent need to address these concerns in future human studies. The immediate symptomatic relief after IACS in TMJ arthritis described in several studies was hitherto observed for only a short period, and growth changes were not recorded in the past as described in the article by Lochbühler 16 . Another interesting finding was that 26% of the TMJ had progressed to severe osseous deformity, including 21% with intraarticular calcifications, which was associated with a high cumulative dose index 16 .…”

“…The immediate symptomatic relief after IACS in TMJ arthritis described in several studies was hitherto observed for only a short period, and growth changes were not recorded in the past as described in the article by Lochbühler 16 . Another interesting finding was that 26% of the TMJ had progressed to severe osseous deformity, including 21% with intraarticular calcifications, which was associated with a high cumulative dose index 16 . Calcification in the TMJ in relation to IACS has been reported to cause ankylosis 19,20 .…”

“…In this issue of The Journal, Lochbühler, et al 16 focus on the use of IACS for the treatment of arthritis in the TMJ of patients with JIA. The Swiss group assessed the immediate and longterm effect of IACS for TMJ arthritis on inflammation and growth disturbances.…”

Assessing Arthritis in the Temporomandibular Joint

“…Therefore all investigators should be aware of the normal appearance of TMJ on their own machine and with their own imaging protocol before TMJ inflammation can be diagnosed and its severity graded. So far, every center, including the Birmingham Alabama group in the report of Stoll, et al, has developed and used its own scoring system for assessing the intensity of inflammation and treatment effect 2,5,15 . Although all scoring systems distinguish between acute inflammatory and more chronic deformative or destructive osteochondral changes, definition of imaging findings and their grading varies.…”

“…Because of the lack of convincing treatment strategies for TMJ arthritis, especially in children, this report is of high interest. While for most other joints IA steroid injections are a recommended treatment option 3 , there is increasing awareness of severe negative effects of steroid injections into the TMJ, such as IA calcifications or ossifications or growth impairment of the mandibular ramus 4,5,6 . Finding an effective treatment alternative for this joint would certainly be intriguing.…”