(87) TMJ Arthrocentesis and TMJ Arthroscopy in Patients With Juvenile Idiopathic Arthritis: How Well Do They Work and How Long Does Their Benefit Last?

Abstract: Juvenile idiopathic arthritis (JIA) is the most common cause of childhood arthritis in the United States, with a high prevalence of TMJ involvement. Although arthrocentesis and arthroscopy are treatment options for TMJ arthritis, the clinical efficacy of these treatments and the duration of clinical benefit remains unclear. The aim of this study is to determine the clinical impact of arthrocentesis and arthroscopy for patients with TMJ arthritis and JIA. A retrospective chart review of subjects with a diagnosis of JIA who had either TMJ arthrocentesis or arthroscopy at Michigan Medicine between 2013 and 2022 was performed. Exclusion criteria consisted of subjects who were over 21 at initial presentation, did not have a formal diagnosis of JIA, or were missing data. The predictor variables were TMJ procedure, type of JIA, use of intra-articular steroid injections, use of DMARD/biologic drugs, age at first intervention, and laterality of the surgery. The outcome variables were jaw function limitation score (JFLS-20), maximum interincisal opening (MIO) in millimeters, current pain on NRS, characteristic pain index (CPI), pain related disability (PRD), and joint pain on loading. The outcome variables were measured at 3 follow-up time periods: early (≤3 months), intermediate, (3-9 months) and late (≥9 months). The sample included 45 subjects (43 female). The mean difference of the outcome variables was calculated from baseline to the three postoperative time periods. Descriptive statistics, means, medians, and standard deviations were computed. Change from baseline to post-operative time points were analyzed with a paired t-test, with statistical significance was set at P < .05. Multivariable regression models analyzed the effect of predictors on outcome variables. Among 56 subjects with JIA and TMJ arthritis, 45 were included for analysis. Twelve had TMJ arthrocentesis and 33 had TMJ arthroscopy. JIA subtypes included 12 monoarthritis, 12 oligoarthritis, 16 polyarthritis, 3 systemic, and 2 psoriatic arthritis. Eighteen were taking DMARDs, and 14 were taking biologic drugs. Thirty-six (80%) had simultaneous intra-articular corticosteroid injections at the time of their index procedure. Pain on loading was present in 14 subjects. Twenty-five subjects had only one procedure, 12 had two procedures, and 8 had 3 or more procedures. The mean preoperative JFLS-20, pain-free MIO, CPI and PRD were 59.4 (38.39), 29.1 (8.47) mm, 5.7 (2.13), and 2.7 (2.64). At the early follow-up, the average postoperative JFLS-20, pain-free MIO, CPI and PRD were 32.0 (37.29) (43.4% improvement), 35.9 (7.65), 4.8 (2.17), and 2.7 (3.13). At the intermediate follow up, the mean post-operative JFLS-20, pain-free MIO, CPI and PRD were 31.0 (29.48), 38.9 (10.94), 4.2 (1.78) and 1.6 (2.38). At the late follow-up, the mean postoperative JFLS-20, pain-free MIO, CPI, and PRD were 34.1 (31.18), 37.1 (11.13), 4.2 (2.52), and 2.0 (2.31). Postoperatively, statistically significant improvements were seen in JFLS-20 at the short (P = .0041) and medium (P = .0001) follow-up, pain-free MIO at all three follow-ups (P < .0001, P = .0005, P = .0044), and CPI at all 3 follow-ups (P = .0459, P = .0026, P = .011). No significant differences were seen in PRD. Subjects with JIA experienced significant improvements in jaw function, mouth opening, and pain after TMJ arthrocentesis and arthroscopy. The most improvement was between 3 and 9 months after treatment, with a gradual relapse in jaw function at the late postoperative period.

References:
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