Division of Orthodontics, University Clinics of Dental Medicine, University of Geneva, Switzerland.
Division of Oral and Maxillofacial Surgery, Department of Surgery, University Hospital of Geneva, Switzerland.
J Craniomaxillofac Surg. 2020 Aug;48(8):772-778. doi: 10.1016/j.jcms.2020.06.010. Epub 2020 Jun 27.
The objective of this study was to investigate the effect of temporomandibular intra-articular corticosteroid injections (IACS) on pain and mouth opening in children with juvenile idiopathic arthritis (JIA) with temporomandibular joint (TMJ) involvement.
Systematic review and meta-analysis methodology was used, beginning with a comprehensive literature search using MEDLINE, PubMed, EMBASE, Web of Science, and the Cochrane library. The population in question was pediatric patients with a JIA diagnosis and TMJ involvement; the intervention was IACS injections to treat TMJ arthritis; a strict control group was not considered necessary; the outcome was clinical signs of improvement of the TMJ arthritis based on pain and mouth opening capacity (MIO). Data on pain and MIO were extracted from the selected studies, and the methodological quality of studies was assessed according to the ROBINS-I tool. Results from the different studies were combined to calculate the pooled proportion with 95% confidence intervals (CIs) for pain resolution, and pooled mean differences with 95% CIs for improvement in MIO. Heterogeneity of the results among studies was tested using I statistics.
The initial search yielded a total of 330 articles; 11 of these were selected for inclusion in the review. 325 participants were included from the combined studies, with the mean age of participants ranging from 5.3 to 13.6 years. Between 24 and 137 TMJs were selected for each of the studies. The pooled proportion of patients with pain resolution following IACS injection was 78% (95% CI: 59-90%), with large heterogeneity (I = 62%). The pooled gain in MIO following IACS injection was 4.38 mm (95% CI: 2.76-6.00), also with high heterogeneity (I = 67%).
The results suggest that in children diagnosed with JIA with TMJ involvement, IACS injections can help in reducing reported pain and improving mouth opening capacity, albeit with an important variation between studies.
本研究旨在探讨颞下颌关节内皮质类固醇注射（IACS）对患有颞下颌关节（TMJ）受累的幼年特发性关节炎（JIA）儿童疼痛和张口度的影响。
采用系统评价和荟萃分析方法，首先使用 MEDLINE、PubMed、EMBASE、Web of Science 和 Cochrane 图书馆进行全面的文献检索。研究人群为诊断为 JIA 且 TMJ 受累的儿科患者；干预措施为 IACS 注射治疗 TMJ 关节炎；未考虑严格的对照组；结局为根据疼痛和张口度（MIO）评估 TMJ 关节炎的临床改善迹象。从选定的研究中提取疼痛和 MIO 数据，并根据 ROBINS-I 工具评估研究的方法学质量。对不同研究的结果进行合并，计算疼痛缓解的合并比例及其 95%置信区间（CI），并计算 MIO 改善的合并均数差异及其 95%CI。使用 I 统计量检验研究之间结果的异质性。
最初的搜索共产生了 330 篇文章；其中 11 篇被选入综述。从合并研究中纳入了 325 名参与者，参与者的平均年龄在 5.3 至 13.6 岁之间。每项研究选择了 24 至 137 个 TMJ。IACS 注射后疼痛缓解的患者合并比例为 78%（95%CI：59-90%），异质性较大（I=62%）。IACS 注射后 MIO 增加的合并量为 4.38mm（95%CI：2.76-6.00），异质性也很高（I=67%）。
结果表明，在诊断为 TMJ 受累的 JIA 儿童中，IACS 注射可以帮助减轻报告的疼痛并改善张口度，尽管研究之间存在重要差异。
