Oral Medicine
Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study

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Objectives

To investigate subjective, clinical and radiographic findings relating to the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), mixed connective tissue disease (MCTD), ankylosing spondylitis (AS), and spondyloarthropathy (SPA), and to compare the findings with those in age- and sex-matched control subjects.

Study design

Eighty patients (24 with RA, 16 with MCTD, 19 with AS, 21 with SPA) and 80 matched controls participated in the study. Replies to a questionnaire covering oral and TMJ symptoms were analysed in conjunction with medical histories, results of clinical examination of the stomatognathic system, and panoramic and lateral panoramic radiographs.

Results

Patients with rheumatic disease reported severe TMJ symptoms significantly oftener than control subjects (P < .001). Patients with AS reported symptoms most frequently (7/19, 37%). Mean maximal opening of the mouth (SD) was significantly less in patients with rheumatic disease (46.3 mm (8.6 mm)) than in control subjects (55.0 mm (7.4 mm)) (P < .001). Marked erosions were observed in 4 RA patients (17%), 3 MCTD patients (19%), 8 SPA patients (38%), 7 AS patients (37%), and 1 control subject (1%) (P < .001). The existence of erosion was associated with evidence of restricted movement of condyle in panoramic radiographs (P < .001). There was correlation between radiographic findings relating to the TMJ and subjective and clinical stomatognathic-system symptoms in patients with rheumatic disease. Subjective TMJ symptoms were associated with evidence of restricted movement of condyle in panoramic radiographs (P < .001). Impairment of laterotrusion movement was significantly associated with erosion (P < .001).

Conclusions

The TMJ is commonly affected in patients with RA, and in patients with other forms of rheumatic disease. There are associations between radiographic findings and subjective symptoms, and between radiographic findings and restricted TMJ movement. In screening for suspected TMJ destruction, it would be appropriate to look for restricted maximal mouth opening, masticatory muscle tenderness and restricted laterotrusion.

Section snippets

Patients

We studied 80 patients with rheumatic disease (24 with RA, 16 with MCTD, 19 with AS, and 21 with SPA) and 80 matched controls (Table I).

All subjects had given written informed consent to their participation in the study, and the Ethics Committee of Helsinki University Central Hospital had approved the study protocol.

Some patients met current classification criteria for RA,6 MCTD,7 and AS.8 Others, with seronegative oligoarthritis or spondylitis not meeting the diagnostic criteria for AS, were

Subjective symptoms and clinical findings

Subjective TMJ symptoms and clinical findings are shown in Table II, Table III, Table IV. The number of patients with rheumatic disease exhibiting severe TMJ symptoms was significantly higher than the number of control subjects exhibiting such symptoms (P < .001). The AS patients reported TMJ symptoms most often (7/19, 37%). TMJ clicking and crepitation were reported by the patients with rheumatic disease significantly more often than by the control subjects (P = .002 and P < .001, respectively).

Discussion

The term TMJ disorders is used collectively to describe congenital and acquired abnormalities affecting the TMJ. The commonest clinical symptoms are pain in the TMJ area, TMJ clicking and locking, and limitation of opening of the mouth. The symptoms are usually aggravated by function, wide opening for prolonged periods (eg, during dental treatment), and chewing food that is hard or requires much mastication.15 In the study reported here we used routine methods and examination protocols relating

Conclusion

We found a high prevalence of TMJ erosion in all of the groups of patients with rheumatic disease studied, even in the group of MCTD patients. We also found a significant correlation between the radiographic evidence of TMJ erosion and condylar movement, stiffness of the masticatory muscles on palpation, and erosion in all of the patient groups. Accordingly, reduced maximal opening of the mouth, tenderness of the masticatory muscles, and reduced maximal laterotrusion are symptoms that indicate

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    Supported by grants from the Helsinki University Central Hospital, Finnish Dental Foundation, Finnish Women's Dental Foundation, and the Orion Research Foundation.

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