Axis II psychosocial findings predict effectiveness of TMJ hyaluronic acid injections

The objective was to investigate the correlation between levels of
depression, somatization, and pain-related impairment, as assessed by the Research
Diagnostic Criteria for Temporomandibular Disorders(RDC/TMDs) axisII, and the
treatment outcome of a cycle of five weekly injections of hyaluronic acid
immediately following arthrocentesis. 57 consecutive patients with a diagnosis of
temporomandibular joint (TMJ) osteoarthritis according to the RDC/TMD
underwent the treatment protocol and a follow-up assessment at 6 months. Axis II
findings were assessed as potential predictors of improvement in visual analogue
scale (VAS) values at the end of the observation period with respect to baseline. The
percentage of VAS improvement at the end of treatment was inversely related to all
the psychosocial variables. The best fitting model identified pain-related
impairment (p < 0.001) and disability points (p < 0.001) as the most significant
predictors of VAS changes. The percentage of variance in the outcome variable
explained by the significant predictors was high (R2 70.5%). All the RDC/TMD axis
II psychosocial scores (depression, somatization, and pain-related impairment
levels) were inversely correlated with therapeutic outcome. The clinical relevance
of these findings is important, since psychosocial diagnosis may be even more
important than physical evaluation in terms of prognostic impact.

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Gli effetti dell’Acido Ialuronico

Disordini temporomandibolari (TMD) sono condizioni dolorose muscolo-scheletriche caratterizzate da il dolore e la disfunzione dei muscoli del viso e / o nella temporo-mandibolare (ATM).

diversi studi identificato una associazione tra TMD e disturbi al rachide cervicale (CSD) in termini di numero limitato di movimento (ROM) (40% dei casi) e dolore al collo (10% dei casi). In realtà la causa del dolore al collo rimane poco chiaro. Dolore al collo cronico provoca comune nella popolazione adulta generale, con prevalenza del 48% per le donne e 38% per gli uomini, con le costanti denunce in 22% delle donne e il 16% degli uomini.
multiplo modalità di trattamento, senza evidenza certa efficacia, sono ora proposto per la gestione dei dolore al collo cronico. Quando il dolore al collo si osserva in pazienti con disordine temporomandibolare, trattando l’ultimo problema, è frequente una regressione della sintomatologia collo.
Molti studi dimostrano l‘efficacia di ialuronico acido (HA) iniezioni in ATM relative alle proprietà biologiche di questa molecola e sulla cartilagine sinoviale membrana. Lo scopo di questo studio era quello di valutare se un protocollo di trattamento consistente in cinque arthrocenteses settimanalmente più iniezioni di HA, utilizzando medie HA peso molecolare, può essere efficace nel ridurre i sintomi del dolore, sia in TMD e CSD.

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Temporomandibular disorders (TMD) are musculoskeletal pain conditions characterized by
pain and dysfunction in the face muscles and/ or in the temporomandibular joint (TMJ). Several studies
identified an association between TMD and cervical spine disorders (CSD) in terms of limited range of
motion (ROM) (40% of cases) and neck pain (10% of cases). Actually the underlying cause of neck pain
remains unclear. Chronic neck pain results common in the general adult population with prevalence of 48%
for women and 38% for men, with persistent complaints in 22% of women and 16% of men. Multiple
modalities of treatments, without certain evidence of efficacy, are now proposed for the management of
chronic neck pain. When neck pain is observed in patient with temporomandibular disorder, treating the last
problem,is frequent a regression of the neck symptomatology. Many studies show the efficacy of hyaluronic
acid (HA) injections in TMJ related to the biological properties of this molecule on cartilage and synovial
membrane. The aim of the present study was to assess whether a treatment protocol consisting in five
weekly arthrocenteses plus HA injections, using medium-molecular weight HA, could be effective in
reducing pain symptoms, both in TMD and CSD.

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