Intra-Articular Corticosteroids for Temporomandibular Joint Involvement in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis

Abstract

Background & Objective: Temporomandibular joint (TMJ) involvement is a frequent and debilitating complication of juvenile idiopathic arthritis (JIA). Intra-articular corticosteroids (IACs) are widely used, but their clinical effectiveness remains uncertain. This systematic review and meta-analysis evaluated the efficacy of IACs for pain relief and improvement in maximal incisal opening (MIO) in pediatric patients with JIA-associated TMJ involvement. Methodology: PubMed, Embase, and Cochrane CENTRAL were searched from inception to March 2026 without language or date restrictions. Cohort studies reporting pre- and post-IAC outcomes for pain and/or MIO were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle–Ottawa Scale. Meta-analysis was conducted in R using random-effects models. Heterogeneity was assessed using the I² statistic. Results: Ten cohort studies involving 417 pediatric patients were included, with five eligible for meta-analysis. Pain analysis (2 studies) showed a non-significant trend toward improvement after IAC therapy (RR=6.13, 95% CI 0.40–94.84; I²=74.2%). MIO analysis (3 studies) demonstrated a significant improvement in mandibular function (MD=2.71 mm, 95% CI 2.40–3.03; I²=0%). Overall study quality was moderate to high. Publication bias could not be reliably assessed because of the limited number of studies. Conclusion: IAC injections appear to improve mandibular function and may reduce pain in pediatric JIA patients with TMJ involvement. Although current observational evidence supports their use, high-quality randomized controlled trials are needed to confirm efficacy and establish standardized treatment protocols. Key Words: Intra articular corticosteroids, Temporomandibular joint, Juvenile idiopathic. Arthritis.