Clinical Outcomes of Adjunctive Glucosamine-Chondroitin-MSM Supplementation Following Arthrocentesis and Intra-Articular Hyaluronic Acid Injection in TMJ Internal Derangement: A Randomized Clinical Trial
Abstract
Temporomandibular joint (TMJ) internal derangement is a common cause of pain and functional limitation that can negatively affect quality of life. Arthrocentesis combined with intra-articular hyaluronic acid (HA) injection is widely used as a minimally invasive treatment; however, the additional benefit of oral glucosamine–chondroitin–methylsulfonylmethane (GCM) supplementation remains uncertain. This randomized clinical trial included 30 patients with TMJ internal derangement who were randomly allocated to two equal groups. The intervention group received arthrocentesis followed by intra-articular HA injection combined with oral GCM supplementation for three months, whereas the control group received arthrocentesis with HA injection alone. Pain intensity was evaluated using the Visual Analog Scale (VAS), and maximum mouth opening (MMO) was measured at baseline and at 1 week, 1 month, 3 months, and 6 months after treatment. Both groups demonstrated statistically significant reductions in pain and improvements in MMO over time (p < 0.001). Although absolute pain and MMO values differed between groups at certain follow-up intervals, comparisons of changes from baseline revealed no statistically significant differences between the two treatments (p > 0.05). Within the limitations of this study, arthrocentesis combined with intra-articular HA injection was effective in improving clinical outcomes in patients with TMJ internal derangement, whereas adjunctive oral GCM supplementation did not provide additional measurable benefit during the 6-month follow-up period.
Keywords: temporomandibular joint; TMJ internal derangement; arthrocentesis; hyaluronic acid; glucosamine; chondroitin; methylsulfonylmethane; maximum mouth opening; clinical trial.
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Magnusson T, Egermark I, Carlsson GE. A longitudinal epidemiologic study of signs and symptoms of temporomandibular disorders from 15 to 35 years of age. Journal of orofacial pain. 2000;14(4):310-9.
Maia ML, Bonjardim LR, Quintans Jde S, Ribeiro MA, Maia LG, Conti PC. Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review. Journal of applied oral science : revista FOB. 2012;20(6):594-602.
Lei J, Liu MQ, Yap AU, Fu KY. Sleep disturbance and psychologic distress: prevalence and risk indicators for temporomandibular disorders in a Chinese population. Journal of oral & facial pain and headache. 2015;29(1):24-30.
Tuuliainen L, Sipilä K, Mäki P, Könönen M, Suominen AL. Association Between Clinical Signs of Temporomandibular Disorders and Psychological Distress Among an Adult Finnish Population. Journal of oral & facial pain and headache. 2015;29(4):370-7.
Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs & aging. 2007;24(7):573-80.
Chan PS, Caron JP, Rosa GJ, Orth MW. Glucosamine and chondroitin sulfate regulate gene expression and synthesis of nitric oxide and prostaglandin E(2) in articular cartilage explants. Osteoarthritis Cartilage. 2005;13(5):387-94.
Bouloux GF. Temporomandibular joint pain and synovial fluid analysis: a review of the literature. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009;67(11):2497-504.
Matsumoto K, Honda K, Ohshima M, Yamaguchi Y, Nakajima I, Micke P, et al. Cytokine profile in synovial fluid from patients with internal derangement of the temporomandibular joint: a preliminary study. Dento maxillo facial radiology. 2006;35(6):432-41.
Ganti S, Shriram P, Ansari AS, Kapadia JM, Azad A, Dubey A. Evaluation of Effect of Glucosamine-Chondroitin Sulfate, Tramadol, and Sodium Hyaluronic Acid on Expression of Cytokine Levels in Internal Derangement of Temporomandibular Joint. The journal of contemporary dental practice. 2018;19(12):1501-5.
Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 1991;49(11):1163-7; discussion 8-70.
Vingender S, Dőri F, Schmidt P, Hermann P, Vaszilkó MT. Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective study. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery. 2023;51(1):1-6.
Pavelká K, Gatterová J, Olejarová M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Archives of internal medicine. 2002;162(18):2113-23.
Gouze JN, Gouze E, Palmer GD, Kaneto H, Ghivizzani SC, Grodzinsky AJ, et al. Adenovirus-mediated gene transfer of glutamine: fructose-6-phosphate amidotransferase antagonizes the effects of interleukin-1beta on rat chondrocytes. Osteoarthritis Cartilage. 2004;12(3):217-24.
Tennent DJ, Hylden CM, Kocher BK, Aden JK, Johnson AE. A randomized controlled trial evaluating methylsulfonylmethane versus placebo to prevent knee pain in military initial entry trainees. US Army Medical Department journal. 2017(3-17):21-5.
Siewert M, Pokrowiecki R, Zawadzki PJ, Stopa Z. Arthrocentesis of Temporomandibular Joints—A Clinical Comparative Study. Life. 2024;14(12):1594.
Gorrela H, Prameela J, Srinivas G, Reddy BVB, Sudhir M, Arakeri G. Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial. Journal of maxillofacial and oral surgery. 2017;16(4):479-84.
Cen X, Pan X, Zhang B, Liu C, Huang X, Zhao Z. Hyaluronan injection versus oral glucosamine and diclofenac in the treatment of temporomandibular joint osteoarthritis. Clinical oral investigations. 2022;26(3):2703-10.
Wandel S, Jüni P, Tendal B, Nüesch E, Villiger PM, Welton NJ, et al. Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. Bmj. 2010;341:c4675.
Nguyen P, Mohamed SE, Gardiner D, Salinas T. A randomized double-blind clinical trial of the effect of chondroitin sulfate and glucosamine hydrochloride on temporomandibular joint disorders: a pilot study. Cranio : the journal of craniomandibular practice. 2001;19(2):130-9.
Yang W, Liu W, Miao C, Sun H, Li L, Li C. Oral Glucosamine Hydrochloride Combined With Hyaluronate Sodium Intra-Articular Injection for Temporomandibular Joint Osteoarthritis: A Double-Blind Randomized Controlled Trial. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2018;76(10):2066-73.
Derwich M, Górski B, Amm E, Pawłowska E. Oral Glucosamine in the Treatment of Temporomandibular Joint Osteoarthritis: A Systematic Review. International journal of molecular sciences. 2023;24(5).
Cardoneanu A, Macovei LA, Burlui AM, Mihai IR, Bratoiu I, Rezus II, et al. Temporomandibular joint osteoarthritis: pathogenic mechanisms involving the cartilage and subchondral bone, and potential therapeutic strategies for joint regeneration. International journal of molecular sciences. 2022;24(1):171.
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