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- Title
Controversial Aspects of Diagnostics and Therapy of Arthritis of the Temporomandibular Joint in Rheumatoid and Juvenile Idiopathic Arthritis—An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project
- Authors
Schmidt, Christopher; Reich, Rudolf; Koos, Bernd; Ertel, Taila; Ahlers, Marcus Oliver; Arbogast, Martin; Feurer, Ima; Habermann-Krebs, Mario; Hilgenfeld, Tim; Hirsch, Christian; Hügle, Boris; von Kalle, Thekla; Kleinheinz, Johannes; Kolk, Andreas; Ottl, Peter; Pautke, Christoph; Riechmann, Merle; Schön, Andreas; Skroch, Linda; Teschke, Marcus
- Abstract
Introduction: Due to potentially severe sequelae (impaired growth, condylar resorption, and ankylosis) early diagnosis of chronic rheumatic arthritis of the temporomandibular joint (TMJ) and timely onset of therapy are essential. Aim: Owing to very limited evidence the aim of the study was to identify and discuss controversial topics in the guideline development to promote further focused research. Methods: Through a systematic literature search, 394 out of 3771 publications were included in a German interdisciplinary guideline draft. Two workgroups (1: oral and maxillofacial surgery, 2: interdisciplinary) voted on 77 recommendations/statements, in 2 independent anonymized and blinded consensus phases (Delphi process). Results: The voting results were relatively homogenous, except for a greater proportion of abstentions amongst the interdisciplinary group (p < 0.001). Eighty-four percent of recommendations/statements were approved in the first round, 89% with strong consensus. Fourteen recommendations/statements (18.2%) required a prolonged consensus phase and further discussion. Discussion: Contrast-enhanced MRI was confirmed as the method of choice for the diagnosis of TMJ arthritis. Intraarticular corticosteroid injection is to be limited to therapy-refractory cases and single injection only. In adults, alloplastic joint replacement is preferable to autologous replacement. In children/adolescents, autologous reconstruction may be performed lacking viable alternatives. Alloplastic options are currently still considered experimental.
- Subjects
JUVENILE idiopathic arthritis; TEMPOROMANDIBULAR joint; ARTHRITIS; ARTHROPLASTY; CONTRAST-enhanced magnetic resonance imaging; TEMPOROMANDIBULAR disorders
- Publication
Journal of Clinical Medicine, 2022, Vol 11, Issue 7, p1761
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm11071761