Pediatric Rheumatology Online Journal → June 2003 → Medical Treatment → Intra-articular steroids→ Abstract #62

TEMPOROMANDIBULAR JOINT CORTICOSTEROID INJECTIONS IN JUVENILE RHEUMATOID ARTHRITIS

E. M. Morgan DeWitt,¹ R. Kaye,² R. Towbin,² R. Q. Cron.¹

¹Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; ²Radiology, Childrens Hospital of Philadelphia, Philadelphia, PA

INTRODUCTION: Micrognathia and mandibular asymmetry with opening of the jaw are well-documented complications of temporomandibular joint (TMJ) arthritis in JRA.
OBJECTIVE: To prevent sequelae of untreated TMJ disease.
METHODS: Patients with JRA who present with symptoms of TMJ arthritis (pain, difficulty chewing), or have suggestive physical exam findings (asymmetric jaw deviation, tenderness, crepitus, narrow tooth-to-tooth gap) are referred for Magnetic Resonance Imaging (MRI). If the MRI result shows evidence of active arthritis (joint effusion, synovial proliferation) the patient is referred for corticosteroid joint injection. The Interventional Radiology team performs TMJ injections under CT guidance. Typically Kenalog (Triamcinolone Acetonide 40mg/ml) 1 ml is injected into each affected joint.
PRELIMINARY DATA: 10 clinic patients have undergone the procedure since July, 2002. 9 female, 1 male, 5 with Pauciarticular, 4 Polyarticular and 1 Systemic Onset JRA. 8 of 10 were ANA +, five were tested for Rheumatoid Factor and were negative. On follow-up visit (only 4 of 10 seen in follow-up to date), 2 of 4 had increased inter-incisor distance (36mm to 42mm, and 37mm to 42mm), one unchanged, and one not measured. 2 were clinically improved with decreased pain, or better mouth opening and chewing function.1 reported increased pain and difficulty closing the mouth, but had measured increased mouth opening by 5mm, the other had no comment recorded in the chart.
CONCLUSIONS: In our small sample of patients undergoing corticosteroid TMJ injections whom we have seen in follow up, 2 of 4 patients noted clinical improvement. One patient who noted increased symptoms had improvement on physical examination. Comment of the fourth patient was not recorded. Aggressive identification of and then management of TMJ arthritis by local corticosteroid injection may prevent the pain, dysfunction and micrognathia associated with under-treatment.