Outcomes of arthrocentesis and arthroscopy in the management of TMJ involvement in juvenile idiopathic arthritis: a retrospective analysis
5 affiliations
- 1Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel- Hashomer, Israel
- 2Department of Oral and Maxillofacial Surgery, School of Dentistry, University of Michigan, Ann Arbor, MI USA
- 3Department of Biostatistics, University of Michigan, Ann Arbor, MI USA
- 4Department of Oral and Maxillofacial, Denver Health, Colorado, USA
- 5Private Practice, The International Center for TMJ and Jaw Surgery, VA Arlington, USA
Abstract
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12969-026-01254-z.
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BibTeX
@article{akerman2026outcomes,
title = {{Outcomes of arthrocentesis and arthroscopy in the management of TMJ involvement in juvenile idiopathic arthritis: a retrospective analysis}},
author = {Eyal Akerman and Ryan McLean and Jonathan Troost and Sara Anderson and Sean P. Edwards and Mohamed Hakim and Jennifer Ash and Sharon Aronovich},
journal = {Pediatric Rheumatology},
year = {2026},
month = jul,
doi = {10.1186/s12969-026-01254-z},
url = {https://doi.org/10.1186/s12969-026-01254-z},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Outcomes of arthrocentesis and arthroscopy in the management of TMJ involvement in juvenile idiopathic arthritis: a retrospective analysis
AU - Eyal Akerman
AU - Ryan McLean
AU - Jonathan Troost
AU - Sara Anderson
AU - Sean P. Edwards
AU - Mohamed Hakim
AU - Jennifer Ash
AU - Sharon Aronovich
PY - 2026
DA - 2026/07/31
JO - Pediatric Rheumatology
DO - 10.1186/s12969-026-01254-z
UR - https://doi.org/10.1186/s12969-026-01254-z
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12969-026-01254-z.
SN - 1546-0096
ER -