scholarly journals Corticosteroid injections in the temporomandibular joint temporarily alleviate pain and improve function in rheumatoid arthritis

2021 ◽  
Author(s):  
Johanna Margaretha Kroese ◽  
Sigvard Kopp ◽  
Frank Lobbezoo ◽  
Per Alstergren
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Intensity ◽  
Temporomandibular Joint ◽  
Corticosteroid Injection ◽  
Treatment Options ◽  
Mouth Opening ◽  
Open Bite ◽  
Anterior Open Bite ◽  
Tmj Pain ◽  
Corticosteroid Injections

Abstract Objectives To evaluate the effect of corticosteroid injections in the painful temporomandibular joint (TMJ) of patients with rheumatoid arthritis (RA) in relation to systemic inflammatory activity. Method Examination of 35 patients (median age 54 years; 89% female) included maximum mouth opening capacity, degree of anterior open bite (AOB), TMJ pain intensity at rest, and crepitus. Serum levels of rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serotonin, and plasma levels of interleukine-1β (IL-1β) were determined. Out of the 70 examined joints, 53 joints received a corticosteroid (methylprednisolone) injection after the clinical examination at baseline (T0). The examination was repeated for all patients at T1 (median 3.1 weeks after T0), and for 21 patients at T2 (median 6.3 weeks after T1), of whom 20 patients received a second injection at T1. Results Maximum mouth opening capacity significantly increased, and TMJ pain intensity significantly decreased between T0 and T1, but these improvements were no longer present at T2. No differences were found in AOB between the time points. Of the joints that received an injection at T0, 19 joints had pretreatment crepitus, which resolved in eight joints at T1. No correlations were found between the change in mouth opening capacity or TMJ pain intensity and ESR, CRP, serotonin, or IL-1β. Conclusions Methylprednisolone injections in the TMJ alleviate pain and improve mouth opening capacity for approximately 3 weeks, allowing patients to perform jaw exercises during this timeframe of temporary relief. It thus seems useful for the short-term management of TMJ involvement in RA. Key Points• In rheumatoid arthritis, corticosteroid injection in the temporomandibular joint alleviates pain and improves function.• The clinical improvement achieved with methylprednisolone injections lasts for approximately 3 weeks.• Corticosteroid injections could be used to facilitate and support additional noninvasive, conservative treatment options.

scholarly journals Impact of Temporomandibular Joint Pain in Rheumatoid Arthritis

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Neveen Ahmed ◽  
Hamid Masoud Mustafa ◽  
Anca Irinel Catrina ◽  
Per Alstergren
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Pain Intensity ◽  
Temporomandibular Joint ◽  
Mouth Opening ◽  
Daily Activities ◽  
Inflammatory Activity ◽  
Tmj Pain ◽  
The Impact

To investigate the impact of temporomandibular joint (TMJ) pain on daily activities and quality of life in relation to systemic inflammatory activity in patients with rheumatoid arthritis (RA), thirty-three consecutive outpatients with RA were included. TMJ pain intensity at rest, on maximum mouth opening, and on chewing was assessed on a 0–10 numerical rating scale. TMJ palpatory tenderness, degree of anterior open bite, the impact of TMJ pain on daily activities and quality of life were also assessed. The systemic inflammatory activity was estimated by the disease activity score 28 (DAS28), blood levels of inflammatory markers and number of painful musculoskeletal regions. TMJ pain at rest, on maximum mouth opening, and on chewing as well as DAS28 was correlated with the impact of the TMJ pain on daily activities and quality of life. Partial correlations showed a significant interaction between TMJ pain on movement and DAS28 that explained the TMJ pain impact on daily activities and quality of life to a significant degree. This study indicates that both current TMJ pain intensity and systemic inflammatory activity play roles in the impact of TMJ pain on daily living and quality of life in RA.

scholarly journals The Temporomandibular Joint in a Rheumatoid Arthritis Patient after Orthodontic Treatment

2009 ◽  
Vol 79 (4) ◽  
pp. 804-811 ◽  
Author(s):  
Kenichi Sasaguri ◽  
Rika Ishizaki-Takeuchi ◽  
Sakurako Kuramae ◽  
Eliana Midori Tanaka ◽  
Takashi Sakurai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Mouth Opening ◽  
Pharmacological Therapy ◽  
Open Bite ◽  
Anterior Open Bite ◽  
Orthodontic Therapy ◽  
Japanese Female ◽  
Severe Erosion ◽  
Old Japanese ◽  
History Of

Abstract A 32-year-old Japanese female patient consulted the authors' dental clinic with a 4.5-year history of rheumatoid arthritis (RA). She complained of pain during mouth opening and difficulty in eating due to masticatory dysfunction caused by an anterior open bite. Imaging showed severe erosion and flattening of both condyles. RA stabilized after pharmacological therapy and became inactive during the orthodontic therapy aimed at reconstructing an optimal occlusion capable of promoting functional repositioning of the mandible. At present, 4 years and 2 months postretention, the reconstructed occlusion remains stable, and both condyles continue to be remodeled. The distance from reference position to intercuspal position has gradually decreased throughout the 4-year posttreatment and postretention periods. Orthodontic therapy that comprehensively reconstructs occlusion and enhances the functioning of the mandible can induce remodeling of eroded condyles, even those with a history of rheumatoid arthritis.

scholarly journals AB0192 EVALUATION OF TEMPOROMANDIBULAR JOINT INVOLVEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1120.1-1120
Author(s):  
M. Brahem ◽  
A. Ben Salem ◽  
H. Hachfi ◽  
R. Sarraj ◽  
S. Abedallatif ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Temporomandibular Joint ◽  
Mouth Opening ◽  
Signs And Symptoms ◽  
Chronic Inflammatory Disease ◽  
Joint Involvement ◽  
Disease Course ◽  
Cross Sectional ◽  
Functional Difficulties ◽  
Tmj Pain

Background:Rheumatoid Arthritis (RA) is the most common chronic inflammatory disease usually involves peripheral joints with a symmetric distribution. The temporomandibular joint (TMJ) is seldom joint to be affected first in the disease course.Objectives:The Aim of our study is to describe and to assess the prevalence of temporomandibular joint (TMJ)disorders in patients with Rheumatoid arthritis (RA).Methods:A cross sectional study including RA patients, which consulted or were hospitalized in Rheumatology department in Taher Sfar Hospital of Mahdia Tunisia, during a period of 10 months. The diagnosis of the RA was secured by the ACR/EULAR 2010, Rheumatoid Arthritis Classification Criteria. The clinical TMJ examination was performed by a trained dentist in the same hospital. We assessed TMJ pain with VAS (visual analog scale) which varies from 0 to 10. The following key parameters were evaluated: The pain on the TMJs by bilateral palpation; The TMJ sounds (clicking or crepitus) during opening closing of the mandible; dysfunction and movement alterations. Clinical and sociodemographic parameters were also determined.Results:Our study included 51 patients with an average age of 51.11 years ±12.4 [21-74years]. 50patients (92.6%of cases) were women and 8 patients (14.8%) were diabetic. Only one patient was a smoker. The mean duration of RA was 10.7 years 7.7± [10months-35years]. Rheumatoid factor (RF) was positive in 25 Patients (46.3%of cases). Anti-citrullinated peptide antibody (ACPA) was positive in 32 patients (59.3 %).41patients (75.4%) had radiological impairments and 28 (51.9%) had specific deformations of RA. The average disease activity score (DAS28-VS) and (DAS28-CRP) were respectively 4.1±1.5 [1.4-7.3] and 3.4±1.5 [1.24-6.71]. TMJ pain was present in 29 patients (56.9 %) which67.7% appeared before ten years. 5 patients (16.7%) had VAS more than 7 that mean a severe pain. TMJ involvement was bilateral in 64.3% and unilateral in 35.7 %. Functional difficulties were detected in 22 patients (44.9 %). TMJ examination had also revealed a limitation of mouth opening in 11 patients (21.2 %), a movement alteration in 13 patients (27.79 %), a clicking in joint mobility in 13 patients (81.3 %) and joint crepitus in 1 patient (6.3%). Disease duration was associated with TMJ pain(p=0.05) and mobility alterations (p=0.04). Functional difficulties of the TMJ were correlated with DAS28 (p=0.02). In our study we found also that duration of corticosteroid therapy had in impact on TMJ pain (p=0.01), functional difficulties (p=0.01) and movements alterations (p=0.004).Conclusion:TMJ is very rare to be affected in the early phase of the disease, thus patient may develop signs and symptoms in the course of time. Our study showed the frequency of TMJ disorders and the most important factors were the activity of RA and the duration of the disease course.Disclosure of Interests:None declared

scholarly journals An Interesting Case of Gunshot Injury to the Temporomandibular Joint

2015 ◽  
Vol 8 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Mário Sergio Medeiros Pires ◽  
CarolineComis Giongo ◽  
Guilherme de Marco Antonello ◽  
Ricardo Torres do Couto ◽  
Ruy de Oliveira Veras Filho ◽  
...  
Keyword(s):  
Temporomandibular Joint ◽  
Present Report ◽  
Mouth Opening ◽  
Interesting Case ◽  
Open Bite ◽  
Gunshot Injury ◽  
Surrounding Tissue ◽  
Tissue Destruction ◽  
Anterior Open Bite ◽  
Trauma Surgeons

The head and face are relatively common sites of gunshot injury, and the temporomandibular joint is often affected. These wounds usually produce major deformity and functional impairment, particularly when the temporomandibular joint is affected or when structures such as the facial nerve are damaged. Complications may include mandibular displacement at maximum mouth opening and in protrusion, limited mouth opening, limited lateral movement of the jaw, anterior open bite, and, more rarely, temporomandibular ankylosis. Projectiles that strike the mandible usually cause comminuted fractures; maxillary wounds, in turn, are most commonly perforating. The present report describes a case of gunshot injury in which the projectile lodged within the mandibular fossa but did not cause any fractures. Oral and maxillofacial trauma surgeons must be aware of the different types of gunshot injury, as they produce distinct patterns of tissue destruction due to projectile trajectory and release of kinetic energy into surrounding tissue.

Idiopathic condylar resorption in orthodontics

2021 ◽  
Vol 14 (2) ◽  
pp. 82-88
Author(s):  
Salwa El-Habbash ◽  
Timothy McSwiney
Keyword(s):  
Risk Factors ◽  
Orthognathic Surgery ◽  
Mechanical Load ◽  
Systemic Disease ◽  
Treatment Options ◽  
Open Bite ◽  
Mandibular Movement ◽  
Anterior Open Bite ◽  
Surgical Risk ◽  
Multiple Treatment

Condylar resorption (CR) can be categorized into functional and dysfunctional remodelling of the temporomandibular joint (TMJ). The literature describes dysfunctional remodelling of the TMJ as idiopathic condylar resorption (ICR). Idiopathic condylar resorption (ICR) is a well-documented but poorly understood pathological entity that can occur spontaneously or post-orthognathic surgery. It predominantly affects young women, with other risk factors including Class 2 malocclusion with steep mandibular plane angles. It is distinguished by a decreased condylar head volume and ramus height, progressive mandibular retrusion and an anterior open bite. Its aetiology can be categorized into surgical and non-surgical risk factors. These include hormones, systemic disease, trauma, mechanical load and surgical risk factors, such as magnitude and direction of mandibular movement, type of surgical fixation and length of post-operative maxilla-mandibular fixation. ICR is a diagnosis of exclusion, and identified by a combination of clinical, radiographic and haematological findings. Multiple treatment options have been described in the literature, including medical management, orthodontics, orthognathic surgery, TMJ surgery, TMJ and orthognathic surgery combined, and total joint prosthesis reconstruction. Further research is required to better understand the aetiology of ICR and more long-term, controlled, multicentre clinical studies are needed to evaluate the outcomes of surgical and non-surgical management of CR patients. CPD/Clinical Relevance: Idiopathic condylar resorption has many presentations and potential causes that can greatly impact the decisions and outcomes for orthodontic/orthognathic treatment.

Etanercept Compared to Intraarticular Corticosteroid Injection in Rheumatoid Arthritis: Double-blind, Randomized Pilot Study

2011 ◽  
Vol 38 (6) ◽  
pp. 1009-1011 ◽  
Author(s):  
CHRISTIAN H. ROUX ◽  
VERONIQUE BREUIL ◽  
LAURE VALERIO ◽  
NICOLAS AMORETTI ◽  
OLIVIER BROCQ ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Α ◽  
Corticosteroid Injection ◽  
Double Blind ◽  
Steroid Injections ◽  
Significant Difference ◽  
Factor Α ◽  
Necrosis Factor ◽  
Corticosteroid Injections

Objective.To compare etanercept (anti-tumor necrosis factor-α) with intraarticular (IA) corticosteroid injections to treat rheumatoid arthritis (RA).Methods.Patients with RA who had persistent monoarthritis received etanercept or IA corticosteroid injections. Efficacy was compared at Weeks 4 and 24.Results.Thirty-four patients were included (8 dropped out). Mean age was 58.8 years. No difference between groups was found at Weeks 4 or 24, but both groups showed significant improvement at Weeks 4 and 24 compared to baseline.Conclusion.Etanercept and IA steroid injections resulted in significant improvement at Week 4 that persisted to Week 24. There was no significant difference in outcome between the groups.

scholarly journals Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

2012 ◽  
Vol 23 (6) ◽  
pp. 779-782 ◽  
Author(s):  
Carolina Ortigosa Cunha ◽  
Lívia Maria Sales Pinto ◽  
Luana Menezes de Mendonça ◽  
Aline Dantas Diógenes Saldanha ◽  
Ana Cláudia de Castro Ferreira Conti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Temporomandibular Joint ◽  
Correct Diagnosis ◽  
Mouth Opening ◽  
Limited Range ◽  
Contralateral Side ◽  
Limited Mouth Opening ◽  
Tmj Ankylosis ◽  
Inflammatory Conditions ◽  
Limited Range Of Motion

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

Coronoidoplasty in TMJ ankylosis treatment

2020 ◽  
Vol 13 (8) ◽  
pp. e235698
Author(s):  
Daniel Sathiya Sundaram Selvaraj ◽  
Ajish George Ommen ◽  
Jagadish Ebenezer
Keyword(s):  
Temporomandibular Joint ◽  
Treatment Protocol ◽  
Mouth Opening ◽  
Facial Asymmetry ◽  
Open Bite ◽  
Surgical Removal ◽  
Tmj Ankylosis ◽  
Temporomandibular Joint Ankylosis ◽  
The Past ◽  
Joint Ankylosis

A 2-year-old boy was brought by his parents with complaints of difficulty in mouth opening for the past one and half years. He had difficulty in chewing and was malnourished, with developing facial asymmetry. He was diagnosed with right side temporomandibular joint ankylosis. We planned for surgical removal of the ankylotic mass. But we modified the treatment protocol. Instead of doing coronoidectomy after aggressive excision of the ankylotic mass as advocated by Kaban, we did a ‘coronoidoplasty’ after aggressive excision of the ankylotic mass. Coronoidotomy or coronoidectomy is one of the rungs in the treatment ladder that is followed in surgical management of temporomandibular joint ankylosis. But one of the postoperative complications after coronoidectomy is the open bite. The difficulty to close the mouth becomes more pronounced when bilateral coronoidectomy is done. However, ‘coronoidoplasty’, as we have done for this patient retains the action of the temporalis muscle on the mandible in closing the mouth, yet removes the mechanical interference of the coronoid process. Postoperatively the patient was able to clench his teeth well, chew properly and there was no open bite.

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