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

Christopher Schmidt; Rudolf Reich; Bernd Koos; Taila Ertel; Marcus Oliver Ahlers; Martin Arbogast; Ima Feurer; Mario Habermann-Krebs; Tim Hilgenfeld; Christian Hirsch; Boris Hügle; Thekla von Kalle; Johannes Kleinheinz; Andreas Kolk; Peter Ottl; Christoph Pautke; Merle Riechmann; Andreas Schön; Linda Skroch; Marcus Teschke; Wolfgang Wuest; Andreas Neff

doi:10.3390/jcm11071761

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

J Clin Med. 2022 Mar 22;11(7):1761. doi: 10.3390/jcm11071761.

Authors

Christopher Schmidt¹, Rudolf Reich², Bernd Koos³, Taila Ertel^{1

4}, Marcus Oliver Ahlers^{5

6}, Martin Arbogast⁷, Ima Feurer⁸, Mario Habermann-Krebs⁹, Tim Hilgenfeld¹⁰, Christian Hirsch¹¹, Boris Hügle¹², Thekla von Kalle¹³, Johannes Kleinheinz¹⁴, Andreas Kolk¹⁵, Peter Ottl¹⁶, Christoph Pautke¹⁷, Merle Riechmann¹, Andreas Schön¹⁸, Linda Skroch¹, Marcus Teschke^{19

20}, Wolfgang Wuest²¹, Andreas Neff¹

Affiliations

¹ Department of Oral and Craniomaxillofacial Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps University, 35043 Marburg, Germany.
² Practice for Oral and Maxillofacial Plastic Surgery MVZ R(h)einZahn, 53111 Bonn, Germany.
³ Department of Orthodontics, University Hospital Tübingen, Eberhard Karls University Tübingen, 72074 Tübingen, Germany.
⁴ Medical Clinic, Hospital of Winsen, 21423 Winsen (Luhe), Germany.
⁵ Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Hospital Hamburg-Eppendorf, University of Hamburg, 20146 Hamburg, Germany.
⁶ CMD-Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
⁷ Department of Rheumatic Orthopedics and Hand Surgery, Hospital Oberammergau, 82487 Oberammergau, Germany.
⁸ Physiotherapeutic Practice & Orthopedic Manual Therapy, 78315 Radolfzell-Böhringen, Germany.
⁹ Deutsche Rheuma-Liga Bundesverband e.V. (German Patients' Association for Rheumatic Disorders), 53111 Bonn, Germany.
¹⁰ Department of Neuroradiology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, 69120 Heidelberg, Germany.
¹¹ Clinic of Pediatric Dentistry, University Hospital Leipzig, University of Leipzig, 04103 Leipzig, Germany.
¹² German Centre for Pediatric Rheumatology, Childrens' Hospital Garmisch-Partenkirchen, 82467 Garmisch-Partenkirchen, Germany.
¹³ Department of Pediatric Radiology, Olgahospital, Klinikum Stuttgart, 70174 Stuttgart, Germany.
¹⁴ Department of Cranio-Maxillofacial Surgery, University Hospital Münster, 48169 Münster, Germany.
¹⁵ Department of Oral and Craniomaxillofacial Surgery, University Hospital Innsbruck, Leopold-Franzens-University Innsbruck, 6020 Innsbruck, Austria.
¹⁶ Department of Prosthodontic Dentistry, University Hospital Rostock, University of Rostock, 18057 Rostock, Germany.
¹⁷ Medical Practice & Clinic for Oral and Maxillofacial Surgery, 80333 Munich, Germany.
¹⁸ Medical Practice & Clinic for Oral and Maxillofacial Surgery, 53842 Troisdorf, Germany.
¹⁹ Medical Practice for Oral and Craniomaxillofacial Surgery, 61352 Bad Homburg, Germany.
²⁰ Children's Hospital Wilhelmstift, 22149 Hamburg, Germany.
²¹ Department of Radiology, Hospital Martha Maria Nürnberg, 90491 Nuremberg, Germany.

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.

Keywords: Delphi method; chronic rheumatic arthritis of the temporomandibular joint; consensus; guideline; juvenile idiopathic arthritis; rheumatoid arthritis.