Temporomandibular Joint Involvement and Dental Occlusion in a Group of Adults with Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ) is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the rheumatologist. TMJ complaints are present in about more than 50% of patients of RA. TMJ is usually among the last joint to be involved and is associated with many clinical signs and symptoms of which pain is a major problem leading to inflammation, limited movements, swelling, joint stiffness, and muscle spasm. Here reported case is 64 years old male, ex-smoker, diagnosed case of diabetes mellitus for 7 years, hypertension for 2 years, came to hospital with the complains of pain in left jaw for 1 year. He had no history of other joint pain, morning stiffness or any deformities. The patient was diagnosed as a case of rheumatoid arthritis on the basis of inflammatory monoarthritis with high titer positive RA factor and anti CCP. The patient gradually improved after treatment with methotrexate. Inflammatory markers like ESR dropped down with the clinical improvement. TMJ is seldom joint to be affected first in the disease course. Bangladesh Med J. 2019 Sep; 48 (3): 43-45

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Temporomandibular joint involvement in generalized osteoarthritis and rheumatoid arthritis: Clinical and arthroscopic findings

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/s1010-5182(96)80626-3 ◽

1996 ◽

Vol 24 ◽

pp. 136

Keyword(s):

Rheumatoid Arthritis ◽

Temporomandibular Joint ◽

Joint Involvement ◽

Arthroscopic Findings ◽

Generalized Osteoarthritis

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AB0192 EVALUATION OF TEMPOROMANDIBULAR JOINT INVOLVEMENT IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.4194 ◽

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

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Evaluation of the Prevalence of Temporomandibular Joint Involvement in Rheumatoid Arthritis Using Research Diagnostic Criteria for Temporomandibular Disorders

Journal of Dentistry of Tehran University of Medical Sciences ◽

10.18502/jdt.v15i6.325 ◽

2019 ◽

Cited By ~ 1

Author(s):

Nazanin Mortazavi ◽

Mansour Babaei ◽

Neda Babaee ◽

Hamed Hossein Kazemi ◽

Roozbeh Mortazavi ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Temporomandibular Joint ◽

Diagnostic Criteria ◽

Complete Blood Count ◽

Physical Symptoms ◽

Joint Involvement ◽

Acute Phase Reactants ◽

Significant Public Health ◽

First Time ◽

Research Diagnostic Criteria

Objectives: Temporomandibular joint (TMJ) disorders, known as TMDs, are significant public health problems and may result in pain and disability. In order to determine the prevalence of clinical/subjective TMD in rheumatoid arthritis (RA), we used the research diagnostic criteria (RDC)/TMD axes. We assessed the anti-cyclic citrullinated protein (anti-CCP)-related TMD in RA for the first time. Materials and Methods: Fifty-two RA patients were compared to 47 healthy controls with regard to complete blood count (CBC), serology, acute phase reactants (APR), and TMJ dysfunction. Results: The anti-CCP antibody showed a significant correlation with the development of clinical TMD (P=0.001, 95% confidence interval (CI)=12.4%-35.6%). A prevalence of 50% was calculated through the RDC/TMD for such disorders. In RA patients, statistically significant differences were observed between the groups with and without clinical TMD regarding psychological depression and physical symptoms. Conclusions: According to the results, a significant correlation was found between the anti-CCP antibody and TMD. Therefore, when this antibody is detected in the blood serum, the treatment must be initiated. The RDC/TMD used in this study assessed the prevalence of TMJ dysfunction in conformity with RA-associated TMJ findings previously obtained through other conventional methods

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