Therapeutic potential of perineural injection for temporomandibular joint pain, dysfunction and musculoskeletal ultrasound findings in rheumatoid arthritis patients

Aim of the work: To assess the effectiveness of perineural injection therapy (PIT) as a new modality in the management of chronic pain and dysfunction of the TMJ in RA patients and to study if it has any role in tissue regeneration.Patients and methods: Out of 19 RA patients with persistent TMJ involvement and pain despite receiving systemic treatment, 13 agreed to have PIT and only 11 completed the study; 21 TMJ (10 bilateral and 1 unilateral) were assessed clinically and by using musculoskeletal ultrasound (MSUS). The disease activity score (DAS28) and modified health assessment questionnaire (MHAQ) were assessed. The visual analogue scale (VAS) for pain was evaluated. The affected TMJs received subcutaneous PIT of 4-6 injections (5% dextrose buffered by 1.7-2 cc of 8.4% sodium bicarbonate solution) with a total of 2-4 cc solution/TMJ.Results: All patients were females with mean age of 45.4 +/- 9.9 years, disease duration of 9.5 +/- 4.1 years; baseline DAS28 was 5.6 +/- 1.2 while the median MHAQ was 1.5. There was a significant improvement in VAS for TMJ pain after PIT at rest (from 5 to 3) and at the maximum mouth opening (from 7 to 5) (P < 0.01). The tenderness and Fonesca's scores significantly improved (baseline: 50.7 +/- 19.1 and post-PIT: 40 +/- 19.4) (P < 0.01). As regards MSUS, there was no significant change in all parameters after PIT.Conclusion: There is a potential significant effect of PIT on improving TMJ pain and function in RA patients. The unchanged MSUS findings make its role in tissue regeneration questionable. (C) 2019 Egyptian Society of Rheumatic Diseases. Publishing services provided by Elsevier B.V.