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Background <p>Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is common, frequently underrecognized, and may progress despite minimal symptoms. Untreated TMJ arthritis has been associated with pain, functional limitation, and dentofacial growth disturbance, supporting early identification and intervention even in clinically subtle disease. The role of minimally invasive TMJ procedures remains incompletely defined. The aim of this study was to evaluate patient-reported and clinical outcomes following TMJ arthrocentesis or arthroscopy in patients with symptomatic TMJ involvement associated with JIA.</p> Methods <p>We retrospectively evaluated 45 patients with JIA who underwent TMJ arthrocentesis or arthroscopy between 2014 and 2023. The cohort was 96% female, with a mean age of 15.7 years at first intervention (range, 6.0–23.0 years). TMJ arthrocentesis was performed in 27% of study subjects and arthroscopy in 73%; intra-articular corticosteroid injection was administered in 80%. Outcomes included the patient-completed 20-item Jaw Functional Limitation Scale (JFLS-20), pain measures including the Characteristic Pain Index (CPI) derived from the Graded Chronic Pain Scale, and maximal interincisal opening (MIO) at early (0–3 months), intermediate (3–9 months), and late (9–24 months) follow-up. Regression analyses identified improvement predictors and need for additional surgical intervention.</p> Results <p>Minimally invasive TMJ procedures were associated with significant early and intermediate improvements in function, pain, and mouth opening (<i>p</i> &lt; 0.05). These benefits diminished over time, and recurrent symptoms were common, with 20 study subjects (44%) requiring additional procedures during follow-up. Procedure type and JIA subtype were not associated with outcomes. MRI-confirmed synovitis, greater baseline functional limitation, DMARD use, and younger age predicted greater early improvement. Higher number of tender sites predicted both early pain improvement and increased likelihood of re-intervention.</p> Conclusions <p>Minimally invasive TMJ procedures provide meaningful but often temporary symptomatic relief in JIA-associated TMJ arthritis. High re-intervention rates likely reflect the complex and recurrent nature of TMJ symptoms in this population. These findings support the selective adjunctive use of local TMJ interventions within a multidisciplinary, systemically focused treatment strategy aimed at mitigating symptomatic burden and potential long-term sequelae.</p>

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Outcomes of arthrocentesis and arthroscopy in the management of TMJ involvement in juvenile idiopathic arthritis: a retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Eyal Akerman,
  • Ryan McLean,
  • Jonathan Troost,
  • Sara Anderson,
  • Sean P. Edwards,
  • Mohamed Hakim,
  • Jennifer Ash,
  • Sharon Aronovich

摘要

Background

Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is common, frequently underrecognized, and may progress despite minimal symptoms. Untreated TMJ arthritis has been associated with pain, functional limitation, and dentofacial growth disturbance, supporting early identification and intervention even in clinically subtle disease. The role of minimally invasive TMJ procedures remains incompletely defined. The aim of this study was to evaluate patient-reported and clinical outcomes following TMJ arthrocentesis or arthroscopy in patients with symptomatic TMJ involvement associated with JIA.

Methods

We retrospectively evaluated 45 patients with JIA who underwent TMJ arthrocentesis or arthroscopy between 2014 and 2023. The cohort was 96% female, with a mean age of 15.7 years at first intervention (range, 6.0–23.0 years). TMJ arthrocentesis was performed in 27% of study subjects and arthroscopy in 73%; intra-articular corticosteroid injection was administered in 80%. Outcomes included the patient-completed 20-item Jaw Functional Limitation Scale (JFLS-20), pain measures including the Characteristic Pain Index (CPI) derived from the Graded Chronic Pain Scale, and maximal interincisal opening (MIO) at early (0–3 months), intermediate (3–9 months), and late (9–24 months) follow-up. Regression analyses identified improvement predictors and need for additional surgical intervention.

Results

Minimally invasive TMJ procedures were associated with significant early and intermediate improvements in function, pain, and mouth opening (p < 0.05). These benefits diminished over time, and recurrent symptoms were common, with 20 study subjects (44%) requiring additional procedures during follow-up. Procedure type and JIA subtype were not associated with outcomes. MRI-confirmed synovitis, greater baseline functional limitation, DMARD use, and younger age predicted greater early improvement. Higher number of tender sites predicted both early pain improvement and increased likelihood of re-intervention.

Conclusions

Minimally invasive TMJ procedures provide meaningful but often temporary symptomatic relief in JIA-associated TMJ arthritis. High re-intervention rates likely reflect the complex and recurrent nature of TMJ symptoms in this population. These findings support the selective adjunctive use of local TMJ interventions within a multidisciplinary, systemically focused treatment strategy aimed at mitigating symptomatic burden and potential long-term sequelae.