Evidence map›Paper›PMID 32998740›Full record

ArticlePediatric rheumatology online journal2020

Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study.

Paula Frid, Thomas A Augdal, Tore A Larheim, Josefine Halbig, Veronika Rypdal, Nils Thomas Songstad, Annika Rosén, Karin B Tylleskär, Johanna Rykke Berstad, Berit Flatø and 4 more

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Pediatric rheumatology online journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 2 countries.

Paula FridDepartment of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway. paula.frid@unn.no.ORCID http://orcid.org/0000-0002-7492-3479
Thomas A AugdalPediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Tore A LarheimDepartment of Clinical Dentistry, UiT The Arctic University of Norway, Tromsø, Norway.
Josefine HalbigPublic Dental Service Competence Centre of North Norway, Tromsø, Norway.
Veronika RypdalPediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Nils Thomas SongstadDepartment of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway.
Annika RosénDepartment of Clinical Dentistry, University of Bergen, Bergen, Norway.
Karin B TylleskärDepartment of Pediatrics, Haukeland University Hospital, Bergen, Norway.
Johanna Rykke BerstadDepartment of ENT and Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway.
Berit FlatøDepartment of Rheumatology, Oslo University Hospital, Oslo, Norway.
Peter StoustrupSection of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.
Karen RosendahlPediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
Eva KirkhusDepartment of Radiology, Oslo University Hospital, Oslo, Norway.
Ellen NordalPediatric Research Group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
University Hospital of North Norway · NOOslo University Hospital · NOHaukeland University Hospital · NOAarhus University · DKNorthern Norway Regional Health Authority · NOUiT The Arctic University of Norway · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting.

methodsIn this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation.

resultsAmong the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent.

conclusionsIn this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.

Indexed as

AdolescentAnti-Inflammatory AgentsArthritis, JuvenileChildFemaleGlucocorticoidsHumansInjections, Intra-ArticularMagnetic Resonance ImagingMaleMethylprednisolone AcetateNorwayPilot ProjectsProspective StudiesTemporomandibular Joint DisordersTreatment OutcomeAnti-Inflammatory AgentsGlucocorticoidsMethylprednisolone AcetateTriamcinolone Acetonidetriamcinolone hexacetonideAdverse eventsEfficacyIntraarticular corticosteroidsJuvenile idiopathic arthritisMagnetic resonance imagingTemporomandibular arthritisTemporomandibular joint

Identifiers

PMID32998740
PMCPMC7528594
OpenAlexW3091752012

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.