Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review.

Marcin Derwich,Maria Mitus-Kenig,Elzbieta Pawlowska

doi:10.3390/ijms22147405

Marcin Derwich, Maria Mitus-Kenig + Show 1 more

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https://doi.org/10.3390/ijms22147405

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Abstract

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: “(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))”. After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.

Highlights

According to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), there have been listed twelve different types of temporomandibular disorders (TMD), including: myalgia, local myalgia, myofascial pain, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement with reduction, disc displacement with reduction with intermittent locking, disc displacement without reduction with limited opening, disc displacement without reduction without limited opening, degenerative joint disease and subluxation [1].TMJ arthritic conditions have been subdivided into two groups, namely low-inflammatory and high-inflammatory disorders [2]
- randomized controlled trials - randomized clinical trials - study population: adolescents and adults diagnosed with Temporomandibular joint osteoarthritis (TMJ OA) - methods of treatment: arthrocentesis or arthroscopy with an additional injection of hyaluronic acid (HA), CS and plateletrich plasma (PRP) or intraarticular injections of HA, CS and PRP - papers written in English
When arthrocentesis is not performed, the intraarticular injection of HA is more effective in pain reduction compared to injections of either CS or physiologic saline solution

Summary

Introduction

According to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), there have been listed twelve different types of temporomandibular disorders (TMD), including: myalgia, local myalgia, myofascial pain, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement with reduction, disc displacement with reduction with intermittent locking, disc displacement without reduction with limited opening, disc displacement without reduction without limited opening, degenerative joint disease and subluxation [1].TMJ arthritic conditions have been subdivided into two groups, namely low-inflammatory and high-inflammatory disorders [2]. Osteoarthritis (OA) and post-traumatic arthritis have been classified as low-inflammatory disorders, whereas rheumatoid arthritis, metabolic arthritic diseases (i.e., gout, pseudogout, lupus erythematosus) and infectious arthritis have been classified as high-inflammatory disorders [2]. The general characteristics for low-inflammatory disorders encompass: the involvement of one or both TMJs, the presence of localized pain and the presence of TMJ crepitation. TMJ clicking and the presence of the rheumatological factor are rare, the erythrocyte sedimentation rate (ESR) is often normal, and the cyclic citrullinated peptide antibody (CPP) is normal; the concentration of the C-reactive protein (CRP) may be elevated [2]. Contrary to the low-inflammatory disorders, the high-inflammatory disorders are characterized by bilateral involvement of TMJs, diffused pain, lack of clicking, rare occurrence of crepitation, presence of rheumatoid factor, elevated ESR, CPP and CRP [2]

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