Corticosteroid Injections in the TMJ Moderately Relieved Pain for Patients with Rheumatoid Arthritis
Pain in the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) is related to systemic inflammatory activity and can be debilitating.
The authors studied 35 patients (median age 54 years), of whom 89% were female. They documented maximum mouth opening capacity, degree of anterior open bite (AOB), TMJ pain intensity at rest, and crepitus. The researchers also determined serum levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serotonin, and plasma levels of interleukine-1[beta] (IL-1[beta]).
Of the 70 joints, 53 received a corticosteroid (methylprednisolone) injection after the clinical examination at baseline (T0). The examination was repeated for all patients at T1 (median 3.1 weeks after T0), and for 21 patients at T2 (median 6.3 weeks after T1). Twenty patients received a second injection at T1.
Maximum mouth opening capacity significantly increased, and TMJ pain intensity significantly decreased between T0 and T1 but not by T2. No differences were found in AOB between the time points. Of the joints that were injected at T0, 19 had pretreatment crepitus, which resolved in 8 joints by T1. No correlations were determined between the increase in mouth opening capacity or decrease of TMJ pain intensity and ESR, CRP, serotonin, or IL-1[beta].
The researchers concluded that methylprednisolone injections in the TMJ alleviate pain and improve mouth opening capacity for approximately 3 weeks, allowing patients to perform jaw exercises during this time. Thus, these injections would seem to be useful for the short-term management of TMJ involvement in RA. Corticosteroid injections could be used to facilitate and support additional noninvasive, conservative treatment options. (See: Kroese JM, Kopp S et al. Corticosteroid injections in the temporomandibular joint temporarily alleviate pain and improve function in rheumatoid arthritis. Clin Rheumatol. 2021 Jul 21 [Epub ahead of print]).
Genicular Nerve Radiofrequency Ablation: A Review of Current Status
Genicular nerve radiofrequency ablation (RFA) has been advocated for the past 7 years as management of knee osteoarthritis (KOA). A review of PubMed revealed 73 articles, as use of this technique is increasingly being performed to treat chronic knee pain.
In this article, the authors offer a summary of the relevant neuroanatomy, randomized controlled trials, appropriate patient selection, and safety relating to genicular RFA.
They note that cadaveric studies indicate considerable variability in the location of the genicular nerves, leading to ensuing debate over the appropriate target locations for genicular RFA.
Nevertheless, good outcomes have been obtained in studies targeting only the superior medial genicular nerve, inferior medial genicular nerve, and superior lateral genicular nerve. Other randomized controlled trials demonstrate superiority of genicular RFA compared with intra-articular steroid, viscosupplementation, and oral analgesics.
The researchers conclude that while genicular RFA of the superior medial genicular nerve, inferior medial genicular nerve, and superior lateral genicular nerve appears to be effective for painful KOA, targeting additional sensory nerves may further improve treatment success.
Based on the available data, genicular RFA appears safe, but additional large-scale studies are needed to improve confidence. (See: Conger A, Gililland J, Anderson L, Pelt CE. Genicular nerve radiofrequency ablation for the treatment of painful knee osteoarthritis: current evidence and future directions. Pain Med. 2021 Jul 25; 22[Supplement_1]: S20-S23.)