Does Arthrocentesis Reduce Pain in Patients With Systemic Polyarthritis and Temporomandibular Joint Intra-Articular Pain and Dysfunction?

ackground: Arthrocentesis is effective at reducing pain and improving function in patients with temporomandibular joint intra-articular pain and dysfunction (IPD). It remains unclear if it is equally effective in patients with systemic polyarthritis (SPA) and IPD. Purpose: The purpose of this study was to compare changes in pain and function following arthrocentesis for IPD in subjects with and without SPA. Study design, setting, sample: This retrospective cohort study was conducted on patients diagnosed with IPD, treated with a cycle of 3 arthrocentesis plus hyaluronic acid at the Hospital of Treviso, Italy, between 2022 and 2023. Inclusion criteria were adult patients with or without SPA with IPD unresponsive to first-line treatments. Patients with other systemic diseases, a history of temporomandibular joint surgery, and head/neck trauma were excluded. Predictor variable: The primary predictor variable was presence of SPA (yes/no). Main outcome variable(s): Primary outcome variable was therapeutic effect measured as change in masticatory efficiency, maximum pain at chewing, and maximum pain at rest between T0 (before treatment) and T1 (3 months after treatment). Secondary outcomes were change in range of motion and self-reported functional limitation between T0 and T1. Covariates: Covariates included demographics (age, sex) and surgery (bilateral arthrocentesis). Analyses: Mann-Whitney U test was adopted for single variable analysis of covariates, primary outcome variables, and secondary outcome variables compared to predictor variable (SPA). Spearman correlation test was used to assess the influence of covariates on primary outcome variable. Statistical significance was set at P < .05. Results: Final sample size included 58 subjects, with 29 subjects in each group. Mean age (SD) for IPD with SPA and IPD without SPA groups was 53.5 (±17.6) and 54.9 (±15.6) (P = .7), respectively. Each group contained the same number of males (n = 2) and females (n = 27) (P = .9). No significant differences were found between groups in change of masticatory efficiency (SPA: 45.49 ± 76.56; non-SPA: 38.45 ± 55.68; P = .8), maximum pain at chewing (SPA: -69.14 ± 35.36; non-SPA: -49.64 ± 45.16; P = .6), or maximum pain at rest (SPA: -53.14 ± 46.97; non-SPA: -35.81 ± 90.34; P = .9). Conclusion and relevance: Arthrocentesis with hyaluronic acid appears to be equally effective in subjects with IPD irrespective of the presence of SPA.