Safety and efficacy of US-guided CS injection into temporomandibular joints in children with active JIA

Abstract

To assess the safety and efficacy of US-guided CS injection done by a paediatric rheumatologist into the TM joints (TMJs) in children with JIA. Children with JIA presenting to the rheumatology clinic were assessed for TMJ arthritis. Triamcinolone hexacetonide was injected in children with active arthritis assessed by MRI using US guidance under general anaesthesia by the same paediatric rheumatologist trained in the procedure. Efficacy and safety were assessed post-injection by patient-guided symptoms and physical examination. Thirty-eight children (34 girls) with JIA who had TMJ injection done between January 2009 and January 2011 were included in the analysis. Mean age was 12.25 (± 3.55) (range 5-18) years. The mean disease duration was 4.54 (± 2.73) (range 1.5-11.1) years. Symptoms pre-injection were pain in 17/38 (44.7%), jaw deviation in 14/38 (36.8%), restricted jaw movement in 13/38 (34.2%) and chewing dysfunction in 7/38 (18.4%). Five (12.5%) children had micrognathia. A total of 63 joints were injected. The injection was efficacious in 58/63 (92.06%) joints. All 17 (100%) children had resolution of pain, and chewing dysfunction improved in 5/7 (71.4%). Jaw deviation improved in 13/14 (92.8%). In the 5/63 (7.9%) injections that were not efficacious, two children with both TMJs injected (four joints) had persisting stiffness with chewing dysfunction and one had persistent jaw deviation. One child developed a scar at the site of injection. US-guided CS injection into the TMJ done by a paediatric rheumatologist trained in the procedure is safe with a high rate of success.