Background
Material and methods
Study design and patients
Clinical variables, TMJ examination, and assessment of disease activity
MRI method and outcomes
Injection procedure
Statistical analyses
Results
Demographic and disease activity parameters
Baseline characteristic | Value |
---|---|
Female, no. (%) | 12 (80) |
Age at injections, yrs | 15 (11, 16) |
Age at JIA onset, yrs. | 11 (8, 14) |
Disease duration, yrs. | 1 (0, 5) |
JIA-category, no (%) | |
Oligoarthritis persistent | 6 (40) |
Polyarthritis RF negative | 5 (33) |
Oligoarthritis extended | 3 (20) |
Enthesitis related arthritis | 1 (7) |
Disease activity, no (%)a | |
Active | 15 (100) |
Remission on medication | – |
Remission off medication | – |
Medication baseline, no (%) | |
No DMARDs | 6 (40) |
DMARDs (MTX) | 3 (20) |
Biologics combination | 6 (40) |
Disease activity variables | |
JADAS10 baseline (n = 8) | 15.8 (12.9, 49.1) |
No.of active joints (n = 14) | 2.0 (1.0, 3.0) |
PRpainVAS (n = 10) | 4.8 (3.3, 7.6) |
PRgloVAS (n = 10) | 5.5 (3.3, 7.1) |
MDgloVAS (n = 12) | 2.5 (1.6, 4.5) |
ESR (mm/h) (n = 12) | 6.5 (3.5, 10.5) |
TMJ-examination to injection, days | 14.0 (1.0, 68.0) |
Follow-up, months | 22.0 (16.0, 23.0) |
Injection to 2-months follow-up, (n = 14) | 2.0 (1.8, 3.3) |
Injection to 1-year follow-up, months (n = 15) | 12.0 (11.0, 13.0) |
Injection to 2-year follow-up, months (n = 11) | 22.0 (22.0, 23.0) |
Triamcinolone hexacetonide, dose, mg (n = 14) | 20.0 (9.5, 20.0) |
Methylprednisolone acetate, dose, mg (n = 1) | 40.0 (n = 1) |
Push-pull technique / No. TMJs (%) | 10/22 (46) |
Needle length, mm/ No. TMJs | 25 mm/15, 30 mm/7 |
Clinical outcomes
Pre- injection (T0) | 2-months FU (T1) | 1-year FU (T2) | 2-year FU (T3) | p-value T0-T1 | |
---|---|---|---|---|---|
Median months after IACs | 0 | 2.0 (1.8, 3.3) | 12.0 (11.0, 13.0) | 22.0 (22.0, 23.0) | |
(1st, 3rd quartile) | n = 15 | n = 14 | n = 15 | n = 11 | |
Disease activity, no (%)** | |||||
Active | 15 (100) | 7 (54) n = 13 | 10 (77) n = 13 | 6 (55) | |
Remission on medication | – | 2 (15) n = 13 | 2 (15) n = 13 | 2 (18) | |
Remission off medication | – | 4 (31) n = 13 | 1 (8) n = 13 | 3 (27) | |
Medication *** | |||||
No DMARDs, no (%) | 6 (40) | 5 (39) n = 13 | 4 (27) | 3 (27) | 0.317 a |
DMARDs (MTX), no (%) | 3 (20) | 2 (15) n = 13 | 3 (20) | 3 (27) | |
Biologics comb, no (%) | 6 (40) | 6 (46) n = 13 | 8 (53) | 5 (46) | |
Disease activity measures | |||||
JADAS10 | 15.8 (12.9, 49.1) n = 8 | 11.0 (6.0, 20.0) n = 7 | 12.5 (6.8, 14.5) n = 9 | 8.5 (3.3, 15.3) n = 4 | 0.273b |
No.of active joints | 2.0 (1.0, 3.0) n = 14 | 0.0 (0.0, 2.0) n = 13 | 1.0 (0.0, 1.5) n = 13 | 0.0 (0.0, 1.0) n = 10 | 0.076b |
ESR (mm/h) | 6.5 (3.5, 10.5) n = 12 | 6.0 (3.8, 11.0) n = 10 | 5.0 (3.0, 7.0) n = 11 | 5.5 (3.8, 7.3) n = 10 | 0.445b |
PRpainVAS | 4.8 (3.3, 7.6) n = 10 | 3.5 (0.0, 5.8) n = 8 | 3.8 (1.6, 6.3) n = 10 | 1.5 (0.0, 4.5) n = 4 | 0.500b |
PRgloVAS | 5.5 (3.3, 7.1) n = 10 | 3.5 (0.1, 5.8) n = 8 | 4.0 (1.6, 5.1) n = 10 | 0.5 (0.0, 4.0) n = 4 | 0.345b |
MDgloVAS | 2.5 (1.6, 4.5) n = 12 | 0.5 (0.0, 4.0) n = 10 | 1.5 (0.1, 2.8) n = 12 | 0.0 (0.0, 1.0) n = 7 | 0.207b |
TMJ activity measures | |||||
Pain frequency | 2.0 (0.0, 4.0) | 1.0 (0.0, 2.0) n = 11 | 1.0 (0.0, 2.0) n = 13 | 0.0 (0.0, 2.0) n = 10 | 0.245b |
VAS pain intensity | 3.0 (0.0, 6.5) n = 15 | 2.0 (0.0, 4.5) n = 11 | 2.0 (0.0, 3.5) n = 13 | 0.0 (0.0, 2.1) n = 10 | 0.292b |
VAS jaw function | 3.0 (0.0, 4.3) n = 13 | 0.0 (0.0, 2.4) n = 10 | 0.0 (0.0, 0.0) n = 13 | 0.0 (0.0, 2.8) n = 9 | 0.201b |
Pain indexγ | 6.0 (0.0, 13.0) n = 15 | 2.0 (0.0, 10.0) n = 11 | 2.0 (0.0, 8.5) n = 13 | 0.0 (0.0, 5.3) n = 10 | 0.263b |
MIO (mm) | 44 (36, 48) n = 15 | 45 (43, 47) n = 13 | 45 (42, 49) n = 13 | 46 (45, 48) n = 11 | 0.045b |
MRI outcomes
Pre- injection (T0) | 2- months FU (T1) | 1-year FU (T2) | 2-year FU (T3) | p-value | |
---|---|---|---|---|---|
Mean months after IACs (SD) | 0 n = 15 | 2.4 ± 1.6 n = 14 | 12.3 ± 1.5 n = 15 | 21.5 ± 2.6 n = 11 | |
Additive Inflammatory domain: (Bone marrow edema, bone marrow enhancement, Joint effusion, Synovial thickening, Joint enhancement) | 4.4 ± 1.8 | 3.4 ± 2.0 n = 13 | 3.6 ± 1.7 n = 14 | 2.3 ± 1.7 n = 10 | 0.040* a |
Bone marrow edema | 0.3 ± 0.5 | 0.1 ± 0.3 | 0.1 ± 0.4 n = 14 | 0.0 ± 0.0 n = 10 | 0.500* b |
Bone marrow enhancement | 0.4 ± 0.5 | 0.2 ± 0.4 n = 13 | 0.1 ± 0.4 n = 14 | 0.0 ± 0.0 n = 11 | 0.250* b |
Joint effusion | 0.8 ± 0.9 | 0.7 ± 0.8 n = 14 | 0.6 ± 0.9 n = 14 | 0.3 ± 0.7 n = 10 | 0.705* a |
Synovial thickening | 1.0 ± 0.8 | 1.0 ± 0.8 n = 14 | 1.0 ± 0.8 n = 14 | 0.7 ± 0.8 n = 10 | 1.000* a |
Joint enhancement | 1.9 ± 0.3 | 1.5 ± 0.7 n = 13 | 1.8 ± 0.4 n = 14 | 1.3 ± 0.6 n = 11 | 0.059* a |
Additive Damage domain: (Condylar flattening, erosions, disc abnormalities) | 2.6 ± 1.5 | 2.8 ± 1.5 n = 14 | 2.7 ± 1.6 | 2.5 ± 1.7 n = 10 | 1.000** a |
Condylar flattening | 1.3 ± 0.9 | 1.6 ± 0.8 n = 14 | 1.5 ± 0.9 | 1.5 ± 0.9 n = 11 | 0.157** a |
Erosions | 0.6 ± 0.7 | 0.6 ± 0.8 n = 14 | 0.5 ± 0.8 | 0.4 ± 0.7 n = 10 | 0.655** a |
Disc abnormalities | 0.7 ± 0.5 | 0.6 ± 0.5 n = 14 | 0.7 ± 0.5 | 0.7 ± 0.5 n = 11 | 1.000** b |
Progressive inflammation | 2.6 ± 0.8 | 2.0 ± 1.1 n = 13 | 2.5 ± 1.0 n = 14 | 1.5 ± 0.9 n = 11 | 0.066* a |
Progressive osseous deformity | 2.0 ± 1.3 | 2.1 ± 1.1 n = 14 | 2.0 ± 1.4 | 2.0 ± 1.3 n = 11 | 1.000** a |
MRI score intra-observer agreement
Side effects
Case | M/F | Age Onset | Age Inj | Dose inj (mg) | Medic (T0) | Medic (T1) | Medic (T2) | Medic (T3) | MIO | Pain index | MRI additive inflammatory domaina | MRI Progressive inflammationa | MRI additive damage domaina | MRI progressive osseous deformitya | Comments |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | M | 10 | 10 | 6 | MTX | MTX | MTX | T0: 48 T1: 42 T2: 48 T3: - | T0: 6 T1 T2: 2 T3: - | T0: 6 T1: 4 T2: 6 T3: - | T0: 3 T1: 3 T2: 4 T3: - | T0: 3 T1: 4 T2: 4 T3: - | T0: 3 T1: 3 T2: 4 T3: - | Bilateral IACs Mandibular trauma between T1 and T2 | |
2 | F | 17 | 17 | 8 | MTX | BioCo | BioCo | BioCo | T0: 40 T1: - T2: 37 T3: - | T0: 0 T1: - T2: - T3: - | T0: 3 T1: 2 T2: 5 T3: 1 | T0: 3 T1: 2 T2: 3 T3: 1 | T0: 4 T1: 4 T2: 3 T3: 3 | T0: 3 T1: 3 T2: 3 T3: 3 | Unilateral IACs |
3 | F | 11 | 11 | 8 | MTX | MTX | BioCo | T0: 32 T1: 35 T2: 30 T3: - | T0: 9 T1: 0 T2: 0 T3: - | T0: 5 T1: 5 T2: 5 T3: - | T0: 3 T1: 3 T2: 3 T3: - | T0: 3 T1: 3 T2: 2 T3: - | T0: 3 T1: 2 T2: 0 T3: - | Unilateral IACs | |
4 | F | 13 | 14 | 20 | No DMARD | No DMARD | No DMARD | No DMARD | T0: 44 T1: 48 T2: 41 T3: 47 | T0: 0 T1: 0 T2: 9 T3: 0 | T0: 4 T1: 2 T2: - T3: - T4: - | T0: 4 T1: 1 T2: - T3: 1 T4: 2 | T0: 2 T1: 4 T2: 5 T3: 4 T4: 4 | T0: 2 T1: 2 T2: 3 T3: 3 T4: 3 | Unilateral repeated IACs (13 months interval) |
5 | F | 9 | 15 | 20 | BioCo | BioCo | T0: 48 T1: - T2: - T3: - | T0: 3 T1: - T2: - T3: 0 | T0: 6 T1: - T2: 6 T3: - | T0: 3 T1: - T2: 3 T3: - | T0: 1 T1: - T2: 4 T3: - | T0: 0 T1: - T2: 2 T3: - | Unilateral IACs | ||
6 | F | 9 | 14 | 10 | BioCo | BioCo | BioCo | BioCo | T0: 46 T1: 45 T2: 47 T3: 47 | T0: 5.5 T1: 2 T2: 0 T3: 0 | T0: 1 T1: 1 T2: 1 T3: 1 | T0: 1 T1: 1 T2: 1 T3: 1 | T0: 0 T1: 0 T2: 0 T3: 0 | T0: 0 T1: 0 T2: 0 T3: 0 | Bilateral IACs |
7 | F | 2 | 15 | 20 | No DMARD | No DMARD | No DMARD | MTX | T0: 36 T1: 44 T2: 44 T3: 44 | T0: 36 T1: 10 T2: 6 T3: 0 | T0: 3 T1: 3 T2: 3 T3: 1 | T0: 1 T1: 1 T2: 2 T3: 1 | T0: 1 T1: 2 T2: 1 T3: 1 | T0: 0 T1: 1 T2: 0 T3: 0 | Bilateral IACs |
8 | F | 15 | 16 | 40b | No DMARD | No DMARD | MTX | T0: 45 T1: 46 T2: 50 T3: - | T0: 0 T1: 0 T2: 12 T3: - | T0: 2 T1: 2 T2: 2 T3: - | T0: 2 T1: 2 T2: 2 T3: - | T0: 4 T1: 4 T2: 4 T3: - | T0: 2 T1: 2 T2: 2 T3: - | Unilateral IACs | |
9 | F | 0 | 15 | 20 | BioCo | BioCo | BioCo | No DMARD | T0: 49 T1: 54 T2: 54 T3: 45 | T0: 0 T1: 5 T2: 0 T3: - | T0: 2 T1: 0 T2: 2 T3: 2 | T0: 2 T1: 0 T2: 2 T3: 2 | T0: 4 T1: 2 T2: 2 T3: 2 | T0: 2 T1: 2 T2: 2 T3: 2 | Unilateral IACs |
10 | F | 15 | 16 | 20 | No DMARD | No DMARD | MTX | MTX | T0: 45 T1: 44 T2: 49 T3: 48 | T0: 12 T1: 22.5 T2: 0 T3: 6 | T0: 5 T1: 6 T2: 4 T3: 2 T4: 3 | T0: 3 T1: 3 T2: 3 T3: 1 T4: 3 | T0: 3 T1: 3 T2: 3 T3: 4 T4: 3 | T0: 3 T1: 3 T2: 3 T3: 3 T4: 3 | Unilateral repeated IACs (11 months interval) |
11 | M | 11 | 16 | 20 | No DMARD | No DMARD | No DMARD | No DMARD | T0: 55 T1: 55 T2: 62 T3: 63 | T0: 0 T1: 0 T2: 0 T3: 0 | T0: 5 T1: 4 T2: 2 T3: 5 | T0: 2 T1: 1 T2: 1 T3: 2 | T0: 3 T1: 3 T2: 3 T3: 3 | T0: 3 T1: 2 T2: 2 T3: 2 | Unilateral injection |
12 | M | 8 | 9 | 10 | BioCo | BioCo | BioCo | BioCo | T0: 34 T1: 40 T2: 41 T3: 45 | T0: 7.5 T1: 0 T2: 0 T3: 0 | T0: 7 T1: 3 T2: 1 T3: 0 | T0: 3 T1: 3 T2: 1 T3: 0 | T0: 0 T1: 0 T2: 0 T3: 0 | T0: 0 T1: 0 T2: 0 T3: 0 | Bilateral IACs |
13 | F | 14 | 15 | 16 | BioCo | BioCo | BioCo | BioCo | T0: 42 T1: 44 T2: 45 T3: 46 | T0: 21 T1: 14 T2: 2.5 T3: 5 | T0: 6 T1: 6 T2: 5 T3: 5 | T0: 3 T1: 3 T2: 3 T3: 3 | T0: 5 T1: 5 T2: 5 T3: 5 | T0: 3 T1: 3 T2: 3 T3: 3 | Unilateral IACs |
14 | F | 5 | 11 | 20 | BioCo | BioCo | BioCo | BioCo | T0: 43 T1: 45 T2: 44 T3: 48 | T0: 13 T1: 9 T2: 9 T3: 12 | T0: 5 T1: - T2: 4 T3: 3 | T0: 3 T1: - T2: 3 T3: 3 | T0: 3 T1: 2 T2: 2 T3: - | T0: 3 T1: 3 T2: 3 T3: 3 | Unilateral IACs |
15 | F | 13 | 15 | 20 | No DMARD | - | No DMARD | MTX | T0: 35 T1: 45 T2: 45 T3: 45 | T0: 32 T1: - T2: 8 T3: 3 | T0: 6 T1: 6 T2: 4 T3: 3 | T0: 3 T1: 3 T2: 4 T3: 2 | T0: 3 T1: 3 T2: 3 T3: 3 | T0: 3 T1: 3 T2: 3 T3: 3 | Bilateral IACs |