Efficacy of Local Treatment in Patients With Rheumatic Diseases Affecting the Temporomandibular Joint—A Systematic Review

Background Temporomandibular joint (TMJ) involvement in rheumatic inflammatory arthropathies (RIA) has been sparsely described, and evidence regarding local treatment options for affected TMJs remains limited. Objectives To perform a systematic review (SR) regarding local treatments for TMJ involvement in RIA and evaluate their effects on pain management, disease improvement, quality of life, health economics, and adverse events. Methods According to the PICO framework, patients with RIA were defined as the population, local TMJ treatment as the intervention, and alternative treatments, placebo, or no treatment as comparators. Outcome measures included maximum interincisal opening (MIO) and TMJ pain. A comprehensive search strategy was developed and applied to five databases. Results The search generated 14 193 studies of which 33 met the inclusion criteria. All included studies had moderate or high risk of bias. Meta‐analyses were conducted with due consideration of these limitations. Patients with juvenile idiopathic arthritis (JIA) or RIA (excluding JIA) having total joint replacement were analysed and JIA patients demonstrated better outcome both regarding MIO ( p = 0.006, I 2 = 86.8%) and TMJ pain ( p = 0.02, I 2 = 82.2%). No significant findings were observed in the remaining meta‐analyses. A critical appraisal suggests that intra‐articular corticosteroid injections might be beneficial for JIA patients. Conclusion The listed results have a low level of evidence and should be interpreted with caution. Nevertheless, this appears to be the only SR specifically evaluating local TMJ treatments in RIA. Ways of decreasing bias and increasing cohort sizes seem necessary for expanding knowledge.