Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1

Abstract

Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis. This was a prospective multicenter double-blinded randomized clinical trial.Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized toHA, CS, or LR. All patients underwent arthrocentesis and then the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3months. The primary outcome variable was pain at 1month (by visual analog scale). Secondary outcome variables were pain at 3months and analgesic consumption. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant. One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8years, respectively (P= .02). There was no difference among groups in time to follow-up at 1month (P= .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P= .12) and 36% for left-side procedures (P= .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P= .01) and 34% for left-side procedures (P= .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P < .01) and 37% for left-side procedures (P < .01). There was no difference in pain decrease among groups (P= .55). There was no difference in the use of narcotic (P= .52) or nonsteroidal anti-inflammatory drugs (P= .71) among groups. Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.