Trager Robert J, Vincent David A, Tao Cliff, Dusek Jeffery A
Connor Whole Health, University Hospitals Cleveland Medical Center.
School of Medicine, Case Western Reserve University.
J Can Chiropr Assoc. 2022 Apr;66(1):92-101.
There is limited research regarding management of temporomandibular disorders (TMD) in adolescents with imaging signs of juvenile idiopathic arthritis (JIA). An 11-year-old girl presented to a hospital-based chiropractor for evaluation of a 1.5-year history of unilateral temporomandibular joint (TMJ) pain and trismus. Previously, pediatric rheumatologists diagnosed JIA after contrast-enhanced magnetic resonance imaging revealed edema, effusion, and bilateral anterior disc displacement, and recommended methotrexate, corticosteroid injection, and arthrocentesis. The chiropractor questioned the JIA diagnosis, instead relating symptoms to a mechanical TMD/disc origin. Manual therapy, TMJ exercises, and acupuncture improved TMJ pain and opening. Invasive medical JIA interventions were avoided without long-term recurrence, further questioning the preceding JIA diagnosis. The success of this case suggests that stepped care, beginning with conservative treatment, has value for adolescents with TMD suspect for JIA. Integration of chiropractors and acupuncturists into healthcare institutions may facilitate this care model by affording nonpharmacologic interventions earlier in patient care.
关于患有幼年特发性关节炎（JIA）影像学表现的青少年颞下颌关节紊乱病（TMD）的管理，相关研究有限。一名11岁女孩因单侧颞下颌关节（TMJ）疼痛和牙关紧闭1.5年的病史，前往一家医院的脊椎按摩师处进行评估。此前，儿科风湿病学家在对比增强磁共振成像显示水肿、积液和双侧关节盘前移后，诊断为JIA，并建议使用甲氨蝶呤、皮质类固醇注射和关节穿刺术。脊椎按摩师对JIA的诊断提出质疑，而是将症状归因于机械性TMD/关节盘问题。手法治疗、TMJ锻炼和针灸改善了TMJ疼痛和开口度。避免了侵入性的JIA医疗干预，且未出现长期复发，这进一步质疑了之前的JIA诊断。该病例的成功表明，从保守治疗开始的阶梯式护理，对于疑似JIA的TMD青少年具有价值。将脊椎按摩师和针灸师纳入医疗机构，可通过在患者护理早期提供非药物干预措施，促进这种护理模式。
