Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate

Abstract

The purpose of this study was to compare the efficacy and the complications of intra-articular temporomandibular joint (TMJ) injections in 40 patients with osteoarthritis of the TMJ. The subjects were randomly divided into two groups, and the patients received either two intra-articular injections with sodium hyaluronate or two intra-articular injections with corticosteroids, 14 days apart. The effect of the treatment was evaluated 14 days, 1 and 6 months after the initial injection and was based on the following measurements: pain intensity, pain localization, joint sounds, mandibular function and complications. Both groups of patients had less pain intensity at the 6-month follow-up, and there was significantly less pain intensity in the group of patients receiving sodium hyaluronate compared with corticosteroids (P = 0.001). A decrease in crepitation was seen in both groups. In the 20 subjects receiving sodium hyaluronate both the mandibular vertical opening and protrusion increased significantly (P < 0.000). Lateral movement from the affected side increased both in subjects injected with sodium hyaluronate (P = 0.024), and those injected with corticosteroids (P = 0.042). In conclusion, this study confirms that injections in the TMJ with sodium hyaluronate or corticosteroids may reduce pain and improve function in patients with osteoarthritis. The injections were more effective in patients with only TMJ pain compared with patients suffering from both TMJ and myofascial pain. Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroids. Temporary pain after injections may be observed.

An image-guided technique for puncture of the superior temporomandibular joint cavity: clinical comparison with the conventional puncture technique

“…Sodium hyaluronate has been widely used for patients with various joint disorders. 24,25 However, injection of sodium hyaluronate into the TMJ cavity as well as drug administration and physiotherapy after pumping manipulation treatment may have biased the study results.…”

O uso do hialuronato de sódio no tratamento das disfunções temporomandibulares articulares

“…in addition, regardless of injecting SH or SS, one may emphasize that there will be no bone structure changes, as shown by other authors 37 in a study with 36 patients with bilateral TMJ osteoarthritis (level of evidence 2). Two well-designed clinical trials 35,36 show better results for intra-articular TMJ infiltration with SH as compared to corticosteroids for joint TMD signs and symptoms. Both are effective at the short and long term, however HA has not the undesirable effects which may be induced by corticosteroids 35,36 , that is structural bone changes.…”

“…These studies positively point to the association of HA with arthroscopy and arthrocentesis, showing better results both in the evaluation of intra-articular bone changes and the evaluation of subjective clinical symptoms. Some studies 35,36 have compared HA to the use of corticosteroids (CS). Short term effect (1 month) of intra-articular infiltration of SH or corticosteroids (betamethasone) was compared to a sample 35 of 33 patients with TMJ pain and sensitivity to palpation for at least six months and who had not responded to conservative treatment.…”

“…Results indicate that SH may be used as alternative to corticosteroids for patients with signs of TMJ inflammation, especially those with symptomatic osteoarthritis (level of evidence 3). Another study 36 has compared efficacy and complications of intra-articular TMJ infiltrations in 40 patients with osteoarthritis. Individuals were randomly divided in two groups: patients have received two intra-articular SH injections or two intra-articular SS injections with 14-day interval between them.…”

“…Considering HA properties, viscosuplementation with HA has been used in different joint TMDs, such as reducing and nonreducing disc displacement, osteoarthritis and degenerative joint disease 16,17,20,21,23,[34][35][36][37][38] . A multicenter study 16 involved a sample of 121 participants divided in two parallel groups, who were followed up for six months.…”