Steroid Injection Effective for Tmj Arthritis

NEW YORK (Reuters Health) - Temporomandibular joint (TMJ) arthritis in patients with juvenile arthritis can be relieved with corticosteroid injection, investigators report.

Many TMJ-related symptoms are caused by the effects of physical and emotional stress on the structures around the joint, including the muscles of the jaw, face and neck. Along with arthritis, other symptoms may include popping sounds in the jaw, inability to fully open the mouth, headaches and other types of facial pain.

"TMJ arthritis can be active even when children are being treated with methotrexate and tumor necrosis factor inhibitors, so corticosteroid injection should be strongly considered when TMJ arthritis is diagnosed in children with chronic arthritis," Dr. Randy Q. Cron told Reuters Health.

Cron from Children's Hospital of Philadelphia, Pennsylvania and colleagues investigated the safety and effectiveness of TMJ corticosteroid injections in 23 children between 4 and 16 years old with juvenile idiopathic arthritis.

"TMJ arthritis is very common and often asymptomatic," Cron pointed out. "If you do not screen for it by MRI (the current gold standard and most sensitive modality), you will likely miss it."

Ten of 13 children with jaw pain before treatment experienced complete resolution of pain with chewing and jaw exertion after the corticosteroid injection, the team reports in the journal Arthritis & Rheumatism. Corticosteroid injection also improved jaw locking in two of the three children who had it.

Maximal opening of the jaw increased by at least 0.5 centimeter in 43 percent of the children after corticosteroid injection, the report indicates, with younger patients showing the best response.

TMJ-related swelling resolved in 48 percent of children, the researchers note, but there were no significant changes in bone abnormalities.

Corticosteroid injection resulted in short-term facial swelling in two patients, the results indicate, but no skin inflammation, infection or atrophy beneath the skin occurred.

"We are currently screening children with chronic arthritis at disease onset for TMJ arthritis," Cron said. "We are also trying to find markers that predict TMJ arthritis. Although preliminary, our results suggest that most all children have evidence of TMJ arthritis at disease onset."

Cron recommends treating these children "as early as possible" -- as soon as it is detected.

SOURCE: Arthritis and Rheumatism, November 2005.