Destructive psoriatic arthritis of the temporomandibular joint: a clinical case, an overview of the pathophysiology and its differential diagnoses

Abstract

Background Clinical assessments and uniplanar images in temporomandibular disorders are not always entirely reliable. This predicament is especially important when clinicians need to determine the nature of temporomandibular joint disease, particularly when clinical features are not helpful in determining the diagnosis. Clinical presentation A 63-year-old female patient presented with mild pain in her right TMJ. During routine imaging exams, a destructive monoarticular arthritis was noticed, producing multiple erosions of the mandibular and temporal condyles. In addition, attrition of the ceiling of the glenoid fossa was observed, generating a communication with the endocranium. Only the presumptive biological behavior revealed on TMJ imaging and the appearance of the psoriatic plaques later during follow-up helped the authors to narrow the differential diagnosis. Conclusion The clinical case presented illustrates the difficulties in diagnosing an erosive, seronegative TMJ destruction, suggestive of a systemic arthritis.

Psoriatic arthritis of the temporomandibular joint: A systematic review

“…As a treatment scheme, in five cases were used no‐steroidal anti‐inflammatory drugs 14,15,18,20,22 ; corticosteroids in four cases, 14,18,19,20 ; chemotherapy agents and immune‐system suppressant in four cases 14,15,20,23 ; an occlusal splint in two cases 18,25 ; homeopathy in one case 22 ; and surgical treatment in two cases 19,25 . A positive outcome was reported in eight cases 15,18–23,25 …”

“…19 Among clinical findings, nine cases had limited mouth opening and seven had TMJ pain. The psoriasis manifestations were skin pigmentation, 14 plaque psoriasis on the scalp 15,19,20 on elbows, 21 rash on various parts of the skin, 22 dry mouth and eyes 23 or psoriasis vulgaris on different parts of the skin. 24 Seven cases reported involvement of other joints as well.…”

“…panoramic radiography and computed tomography of TMJs, 25 CT scans of her temporomandibular joints, 19,20,22,23,38 panoramic radiograph and CBCT images for advanced imaging of TMJs, 18,21 MRI 15,20,21,[30][31][32][33] and US. 32,33 MRI a considered the gold standard method, when compared to US examinations.…”

“…20,26,29 Brodalumab subcutaneous injection is a human monoclonal antibody designed for the treatment of inflammatory diseases, 14 with promising results in the treatment of PsA. Homeopathy, 22 topical and systemic medication (Captopril, Atorvastatin, and calcium/vitamin D supplements) 21 were additionally used in PsA patients. Methotrexate was the most frequently used drug in subjects with the polyarticular course as compared to persistent oligoarticular patients 29 with potential liver toxicity after methotrexate treatment.…”

Intermittent intracranial condylar dislocation with minimal functional sequelae

“…DJD of the TMJ is usually associated with thickening of the glenoid fossa 1 . We are aware of only one reported case of glenoid fossa perforation due to erosive TMJ disease 6 . The most common causes of condylar dislocation into the middle cranial fossa are trauma and surgical complications 7 .…”