Inside Pediatrics Spring 2015

Efforts to Unlock the Puzzle of

“We’ve probably pushed forward the screening and treatment of TMJ arthritis in children with JIA as much as anyone I know.” — Randy Cron, M.D.

infliximab [Remicade] and adalimumab [Humira], the TMJ is largely resistant,” he said. In addition to the aggressive systemic therapy, Cron and his team partner with their colleague, Peter Waite, MPH, DDS, M.D. who is chief of oral and maxillofacial surgery at the University of Alabama at Birmingham (UAB.) With the patient under anesthesia, Waite administers intra-articular long-acting corticosteroid injections, much like rheumatologists would do for other treatment refractory joints. The treatment, Cron said, is effective in only about half the cases. For those patients who do not realize significant improvement from the steroids, Waite will subsequently inject the TMJs directly with infliximab, a TNF inhibitor. These intra-articular infliximab injections appear to benefit another 25 percent of patients with refractory TMJ arthritis, but Cron said there is still room for improvement.

Efforts continue in researching effective treatments and improving diagnosis. Vaid and his team have already established international uniform protocols for performing the TMJ MRI scans. He and Saurabh Guleria, M.D., have also developed and published a scoring scheme to provide a grading system for evaluating the extent of both active and chronic TMJ arthritis. “We’ve probably pushed forward the screening and treatment of TMJ arthritis in children with JIA as much as anyone I know,” Cron said. “It’s not a home run, but we’re doing the best we can.” More information is available at www.childrensal.org/ rheumatology .

Dr. Cron and Dr. Yoginder Vaid (below) , radiology, were both invited speakers to the American College of Rheumatology National Scientific Meeting in Boston last year. Cron presented “Development of TMJ Arthritis Clinical Trials” and Vaid presented “A Scoring System for Evaluation of TMJ Arthritis in Children with JIA.”

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