Targeted Assessment of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

doi:10.1016/j.joms.2007.08.037

Journal of Oral and Maxillofacial Surgery

Volume 66, Issue 9, September 2008, Pages 1804-1811

https://doi.org/10.1016/j.joms.2007.08.037 Get rights and content

Purpose

This observational study was done to identify the signs and symptoms of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis (RA) and to assess the association between these and quantitative measurements for the evaluation of rheumatologic disease.

Patients and Methods

The sample comprised 61 patients suffering from RA whose signs and symptoms of TMJ were recorded by means of a questionnaire (scale of limited mandibular function) and clinical measurements (pain during jaw movement, limitation of maximal mouth opening, joint sounds, tenderness on TMJ palpation, tenderness on masticatory muscle palpation). These findings were correlated with the quantitative measurements for evaluating RA: duration of the disease, positivity for rheumatoid factor, Health Assessment Questionnaire (HAQ) score, number of edematous and painful joints, and overall assessment of functional status.

Results

In terms of overall figures, 70.5% of the patients presented with at least 1 sign or symptom, 49.2% had at least 1 symptom, and 54.1% had at least 1 sign. The variable pain on movement was associated with the number of painful joints and the overall assessment findings (P < .05). Sound on movement was positively associated with the number of edematous joints (P = .0291). The scale of limited mandibular function was statistically significantly correlated with 4 quantitative measurements (P = .0283 to .0448). The variable pain on palpation of the masticatory muscles was associated with the number of painful joints (P = .0023). Pain on palpation of the TMJ was statistically significantly associated with the HAQ score (P = .0344) and with the number of painful joints (P = .0006).

Conclusion

A significant percentage of the patients with RA have signs and symptoms of TMJ involvement, and the scale of limited mandibular function proved to be an important measurement tool.

Section snippets

Patients and Methods

The study population comprised patients of both genders and various social backgrounds suffering from RA undergoing treatment at the Department of Rheumatology, Pernambuco Federal University Hospital, between December 2003 and December 2004. The following inclusion criteria were adopted: a diagnosis of RA according to the American College of Rheumatology's 1987 criteria, no previous treatment of any kind for TMJ involvement, and a sufficient number of teeth (or tooth prostheses) for obtaining

Results

The duration of RA ranged from 9 months to 65 years, with a mean of 12 years (standard deviation, 11 years, 3 months). Of the total group, 32.8% had RA of up to 5 years' duration, 24.6% had RA of 5 to 10 years' duration, and 42.6% had RA of more than 10 years' duration. With regard to positivity for rheumatoid factor, 55.7% were positive and 44.3% negative. The HAQ assessment, 32.8% had a score of up to 1 and 67.2% had a score of 1 to 3 (37.7% between 1 and 2 and 29.5% between 2 and 3). Of

Discussion

Performing a targeted assessment of the TMJ in patients with RA requires special care owing to the fact that a large percentage of these patients have symptomatology. In terms of overall figures, 70.5% of the patients presented with at least 1 sign or symptom, 49.2% had at least 1 symptom, and 54.1% had at least 1 sign. These findings are in agreement with other published studies showing that 33% to 66% of the patients with RA have some sign or symptom of TMJ involvement; however, analysis of

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Systemic Factors in Temporomandibular Disorder Pain
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Reconstruction of the TMJ and condyle in inflammatory arthritis
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Citation Excerpt :
Common diagnostic imaging modalities include panoramic radiographs, computerized tomography (CT) scans and magnetic resonance imaging of the TMJ. Frequent findings on these include loss of joint space, articular disc flattening and displacement, osseous changes to both the condyle as well as the articular eminence/glenoid fossa (degeneration or heterotopic bone formation), synovitis and abnormal bone marrow signal.1,14 More advanced destruction of the joint can result in a decrease in condylar height that subsequently leads to the presence of a high occlusal plane angle, increased mandibular plane angle, decreased chin projection, and A-P mandibular deficiency (Fig. 1).
Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.
Alloplastic Temporomandibular Joint Replacement in Patients With Systemic Inflammatory Arthritis and Connective Tissue Disorders
2021, Journal of Oral and Maxillofacial Surgery
We present a retrospective study to report the outcomes of total temporomandibular joint (TMJ TJR) replacement with alloplastic devices in patients suffering from systemic inflammatory arthropathies.
A total of 39 patients with a diagnosis of rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PA), juvenile idiopathic rheumatoid arthritis (JIA), or systemic lupus, underwent alloplastic total joint replacement(s) (TJR) from 1999 to 2019. Maximal interincisal opening (in mm) was recorded before surgery (T0), at 1-year post-surgery (T1) and at last follow-up (T2). A visual analog scale (from 0 to 10) was used for subjective examination of pain before surgery (T0) and at last follow-up (T2). Comparisons were conducted with statistical significance set at P < .05.
Seventy-four joints were replaced in 39 patients. Thirty-two were female. The mean age was 36 years old (range 18-61) and the mean follow-up was 45.9 months (SD 49.4). The most common diagnosis was RA (n = 21), followed by JIA (n = 5) and AS (n = 5), PA (n = 4), lupus (n = 3), and mixed connective tissue disorder (n = 1). The mean pain score had fallen from 6.8 (SD 3.2) at T0 to 1.3 (SD 2.4) (P < .001) at T2. The maximal interincisal opening had improved from a mean of 22.1 mm (SD 13.3) at T0 to 34.3 mm (SD 8.5) (P < .001) at T2. One patient got persistent dysesthesia in the V3 distribution. There were no serious late complications.
Patients suffering from systemic inflammatory arthropathies involving the TMJs can be successfully treated by TJR with alloplastic devices. The long-term reduction of TMJ symptoms and functional improvement in this initial study suggest good predictability for this treatment
Growth pattern and physiological characteristics of the temporomandibular joint studied by histological analysis and static mechanical pressure loading testing
2020, Archives of Oral Biology
The aim of this study was to investigate the age-related changes in the articular disc, condyle, condylar fibrocartilage, and subchondral bone of the temporomandibular joint (TMJ) in rabbits.
Female New Zealand white rabbit aged 1, 4, 12, and 32 weeks were obtained. Each age group comprised 5 rabbits and was subjected to chondrocyte culture, histological assessment of the articular disc length, assessment of the anteroposterior diameter of the condyle, measurement of the fibrocartilage thickness, and assessment of the subchondral bone architecture. The production of Collagen, type II, alpha1 (COL2A1); SOX9; Collagen, type X, alpha1 (COL10A1); and Runt-related transcription factor 2 (Runx2) was detected via western blot. Six rabbits at the ages of 12 and 32 weeks were sacrificed for the mechanical pressure loading test (75 kPa, 3 days). Changes in the condyles after pressurization were observed via scanning electron microscopy and evaluated by micro-CT.
Significant enlargement of the condyle occurred from 4 to 12 weeks of age (p = 0.003); however, the length of the articular disc increased significantly from 1 to 12 weeks of age (p < 0.005). A rapid decrease in the cartilage thickness but an increase in the subchondral bone density occurred from 1 to 4 weeks of age and from 4 to 32 weeks of age in rabbit, respectively (p < 0.05). The expressions of COL2A1 and SOX9 gradually decreased from 1 to 32 weeks of age. The protein expressions of COL10A1 and Runx2 were maintained at a high level at 4–12 weeks of age. After static mechanical pressure loading, the damage and reduction in the bone mineral density (BMD) in the12-week-old group was greater than those in the 32-week-old group.
An inconsistency between the condyle and articular disc during growth and development may be a causal factor for temporomandibular disorders TMDs in adolescents. Our findings suggest that the response of the adult condyle to the mechanical pressure is significantly greater than that of the adolescent condyle; however, with regard to reconstruction, the situation is reversed, which may influence the pathological progress of TMDs.
Temporomandibular Joint Reconstruction in Patients With Autoimmune/Connective Tissue Disease
2018, Journal of Oral and Maxillofacial Surgery
To evaluate clinical outcomes in patients with autoimmune or connective tissue (CT) disease undergoing temporomandibular joint (TMJ) reconstruction.
Patients were divided into 2 groups based on type of TMJ reconstruction. Patients in group 1 (n = 9) underwent autogenous reconstruction and had a diagnosis of rheumatoid arthritis (5), lupus arthritis (1), and psoriatic arthritis (3). Patients in group 2 (n = 2l) had alloplastic reconstruction with a patient-fitted total joint prosthesis (TMJ Concepts, Ventura, CA) and had a diagnosis of rheumatoid arthritis (15), lupus (3), and psoriatic arthritis (3). Standardized clinical and radiographic examinations were performed before surgery, immediately after surgery, and at longest follow-up after surgery (T3).
Group l showed no meaningful improvement in maximal opening without pain, a decrease in lateral excursions, minimal decrease in TMJ pain, and a 32% relapse of chin projection at point B at T3. Average postsurgery follow-up time was 58 months. Postsurgical ankylosis was seen in 22% of patients. In contrast, group 2 showed a statistically meaningful decrease in subjective TMJ pain and lateral excursive movements and improvement in jaw function, diet, maximal incisal opening without pain, and only 5% showed a relapse at point B at T3. Average postsurgical follow-up in this group was 78 months.
Improved treatment outcomes were obtained with alloplastic TMJ total joint reconstruction compared with autogenous TMJ reconstruction in patients with autoimmune or CT disease.
Temporomandibular and Odontological Abnormalities in Patients with Rheumatoid Arthritis
2020, Reumatologia Clinica
Caracterizar las afecciones orofaciales en pacientes con artritis reumatoide (AR) y compararlas con las presentes en pacientes sin la enfermedad de la ciudad de Chihuahua, Chihuahua, México.
El estudio incluyó a 30 pacientes con diagnóstico de AR y 30 pacientes consecutivos en una consulta de odontología. A través de una revisión clínica odontológica, se compararon entre los grupos variables relacionadas con: 1) trastornos clínicos y radiográficos de la articulación temporomandibular, 2) análisis biomecánico craneocervical, 3) estado de la dentición y necesidades de tratamiento, 4) estado periodontal, 5) estado de higiene oral y 6) dolor facial. Además se determinó la asociación entre las variables estudiadas a través de pruebas de correlación.
Los pacientes con AR tuvieron una mayor prevalencia de alteraciones en la articulación temporomandibular, tanto clínicas (100 vs. 60%; p < 0,001) como radiográficas incluyendo erosiones (50 vs. 16; p = 0,010), en comparación con la población de referencia. Además los pacientes con AR tuvieron mayor cantidad de pérdidas dentales (6,9 ± 5,7 vs. 3 ± 2; p = 0,001), caries (13,4 ± 5,4 vs. 4,9 ± 6,5; p = 0,001), periodontitis (1,3 ± 0,9 vs. 0,8 ± 0,8; p = 0,015), higiene oral deficiente (43,3 vs. 13,3%; p = 0,005) y más dolor facial (66,7 vs. 20%; p< 0,001). El análisis de cefalometría de Rocabado mostró diferencias en el ángulo craneocervical y triángulo hioideo entre AR y controles. Se obtuvieron correlaciones significativas entre las alteraciones orales y las temporomandibulares.
Los pacientes con AR mostraron un mayor deterioro orofacial, lo que refleja la importancia de atención multidisciplinaria incluyendo la evaluación odontológica periódica.
To characterize the orofacial abnormalities in patients with rheumatoid arthritis (RA) and compare them with those in a reference population.
The study included 30 RA patients and 30 consecutive patients in an odontology clinic in whom RA was ruled out. Patients underwent a clinical dental examination which included: 1) clinical and radiographic abnormalities of the temporomandibular joint; 2) biomechanical craniocervical analysis; 3) state of dentition and treatment needs; 4) periodontal status; 5) oral hygiene status; and 6) facial pain, which was compared among study groups. In addition, the association between the variables studied was determined through correlation tests.
Patients with RA showed a higher prevalence of temporomandibular abnormalities, both clinical (100.0% vs. 60.0%, P < .001) and radiographic, including erosions (50.0% vs. 16.0%, P = .010), compared with individuals in the control group. Likewise, patients with RA had a greater number of missing teeth (6.9 ± 5.7 vs. 3.0 ± 2.0, P = .001), more caries (13.4 ± 5.4 vs. 4.9 ± 6.5, P = .001), periodontitis (1.3 ± 0.9 vs. 0.8 ± 0.8, P = .015), poorer oral hygiene (43.3% vs. 13.3%, P = .005) and greater facial pain (66.7% vs. 20.0%, P < .001). The cephalometric analysis of Rocabado showed differences in the craniocervical angle and hyoid triangle between RA and controls. Significant correlations were obtained between oral and temporomandibular abnormalities.
Patients with RA showed a greater orofacial deterioration, which reflects the importance of multidisciplinary care, including periodic dental examination.

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Basic and patient-oriented researchTargeted Assessment of the Temporomandibular Joint in Patients With Rheumatoid Arthritis

Purpose

Patients and Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

Int J Oral Maxillofac Surg

Best Pract Res Clin Rheumatol

Br J Oral Surg

Oral Surg Oral Med Oral Pathol

J Dent

Rheum Dis Clin North Am

J Prosthet Dent

Rheumatoid arthritis: Epidemiology, pathology, and pathogenesis

Consenso brasileiro para o diagnóstico e tratamento da artrite reumatóide

Rev Bras Reumatol

Rheumatoid diseases and the temporomandibular joint: A review

Cranio

Rheumatoid arthritis and temporomandibular joint involvement: A literature review

Med Oral

Artrite reumatoide

Impact of temporomandibular joint pain on activities of daily living in patients with rheumatoid arthritis

Acta Odontol Scand

Temporomandibular joint involvement and dental occlusion in a group of adults with rheumatoid arthritis

Acta Odontol Scand

Temporomandibular disorders in rheumatoid arthritis

J Rheumatol

Alterations in the temporomandibular joint at various stages of rheumatoid arthritis

Acta Rheumatol Scand

Basic and patient-oriented research
Targeted Assessment of the Temporomandibular Joint in Patients With Rheumatoid Arthritis