Letter to the Editor
Evaluation of a Patient With Temporomandibular Joint Disorders in Paget's Disease of Bone
Evaluación de un paciente con trastornos de la articulación temporomandibular en la enfermedad ósea de Paget
José Dario Sánchez López
, Paolo Cariati, Miguel Angel Pérez de Perceval Tara
Corresponding author
Servicio de Cirugía Oral y Maxilofacial, Hospital Universitario Virgen de las Nieves, Granada, Spain
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The patient was referred to our department suffering from pain (VAS<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7/10) in the right temporomandibular Joint (TMJ) and a reduction of oral opening (<2.5<span class="elsevierStyleHsp" style=""></span>cm). The examination was completed with computerised axial tomography (CAT) which revealed condylar deformity with osteosclerosis and osteophytes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The diagnosis made was arthropathy of the TMJ and was initially treated with a jaw release splint, rehabilitation exercises, analgesic treatment and muscle relaxants. Following periodic three-monthly check-ups after a year of treatment a reduction in pain was noted (VAS: 3/10) and an increase in joint function with oral opening above 3<span class="elsevierStyleHsp" style=""></span>cm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Involvement of the jawbones and specifically of the TMJ in PDB is a rare occurrence.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Despite not verifying jawbone involvement, and without being able to rule out other causes (osteoarthritis, arthritis), due to the absence of previous events, this case was suggestive of an isolated involvement of the TMJ provoked by continuous stress to which the articular condyles are subjected as a consequence of mastication, leading to degenerative phenomena with episodes of bone remodelling. However, confirmation of this hypothesis would require the undertaking of more specific tests (bone scintigraphy).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical signs of improvement globally appreciated corroborate the current trend<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a> that treatment with second and third generation BPs (pamidronate, alendronate, risedronate, zoledronate) are more effective than calcitonin and etidronate for serum and degenerative disease control.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez López JD, Cariati P, Pérez de Perceval Tara MA. Evaluación de un paciente con trastornos de la articulación temporomandibular en la enfermedad ósea de Paget. Reumatol Clin. 2019;15:e74.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 625 "Ancho" => 750 "Tamanyo" => 30080 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan showing condylar deformity with osteosclerosis, flattening and osteophytes.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis and management of Paget's disease of bone" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.H. Ralston" 1 => "A.L. 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| 2024 May | 35 | 22 | 57 |
| 2024 April | 44 | 22 | 66 |
| 2024 March | 39 | 26 | 65 |
| 2024 February | 28 | 25 | 53 |
| 2024 January | 44 | 18 | 62 |
| 2023 December | 39 | 28 | 67 |
| 2023 November | 53 | 34 | 87 |
| 2023 October | 33 | 35 | 68 |
| 2023 September | 64 | 38 | 102 |
| 2023 August | 35 | 18 | 53 |
| 2023 July | 43 | 20 | 63 |
| 2023 June | 38 | 22 | 60 |
| 2023 May | 41 | 21 | 62 |
| 2023 April | 30 | 7 | 37 |
| 2023 March | 56 | 25 | 81 |
| 2023 February | 44 | 22 | 66 |
| 2023 January | 44 | 10 | 54 |
| 2022 December | 53 | 18 | 71 |
| 2022 November | 40 | 21 | 61 |
| 2022 October | 44 | 30 | 74 |
| 2022 September | 42 | 30 | 72 |
| 2022 August | 38 | 39 | 77 |
| 2022 July | 35 | 29 | 64 |
| 2022 June | 50 | 28 | 78 |
| 2022 May | 38 | 42 | 80 |
| 2022 April | 49 | 40 | 89 |
| 2022 March | 46 | 43 | 89 |
| 2022 February | 59 | 29 | 88 |
| 2022 January | 46 | 37 | 83 |
| 2021 December | 37 | 42 | 79 |
| 2021 November | 41 | 38 | 79 |
| 2021 October | 53 | 53 | 106 |
| 2021 September | 35 | 34 | 69 |
| 2021 August | 38 | 29 | 67 |
| 2021 July | 28 | 24 | 52 |
| 2021 June | 28 | 29 | 57 |
| 2021 May | 48 | 35 | 83 |
| 2021 April | 80 | 77 | 157 |
| 2021 March | 46 | 38 | 84 |
| 2021 February | 42 | 17 | 59 |
| 2021 January | 40 | 23 | 63 |
| 2020 December | 32 | 20 | 52 |
| 2020 November | 85 | 13 | 98 |
| 2020 October | 80 | 19 | 99 |
| 2020 September | 32 | 26 | 58 |
| 2020 August | 29 | 20 | 49 |
| 2020 July | 26 | 13 | 39 |
| 2020 June | 26 | 14 | 40 |
| 2020 May | 28 | 13 | 41 |
| 2020 April | 20 | 16 | 36 |
| 2020 March | 3 | 1 | 4 |
| 2019 November | 1 | 0 | 1 |
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