Temporomandibular disorders: relationship between joint pain and effusion and nitric oxide concentration in the joint fluid.

Suenaga, Shigeaki; Abeyama, Kazuhiro; Hamasaki, Azumi; Mimura, Takuji; Noikura, Takenori

doi:10.1038/sj.dmfr.4600610

Cited by 40 publications

(36 citation statements)

References 30 publications

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“…2 Further, MRI reveals other conditions that could be associated with TMJ pain, such as bone marrow abnormalities 3 and joint effusion. 4 An imaging examination, as well as other diagnostic tests, can be justified only if the results of the examination contain information that leads to a more accurate diagnosis and thus influences the choice of treatment and the prognosis. The diagnostic method should not only be accurate in distinguishing between diseased and healthy individuals but also be reliable in its observer independence, as it is well known that the diagnostic outcome is influenced by variations in the performance of different observers.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

et al. 2004

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Objective. The purpose of this study was to estimate the inter-and intraobserver agreement for interpreting magnetic resonance (MR) images of the temporomandibular joint (TMJ). Methods. The study was based on MR images of 30 TMJs. The images were interpreted by seven observers for disk configuration, disk position, joint fluid, bone marrow changes, and diagnosis. The observers were not calibrated. Kappa statistics were used. Results. The kappa values were, for interobserver agreement of disk configuration, 0.10; for disk position in the sagittal plane with closed mouth, 0.35; for a combination of closed mouth and open mouth, 0.44; for disk position in the coronal plane, 0.17; for joint fluid, 0.36; for bone marrow changes, 0.01; and for diagnosis, 0.39. Intraobserver agreement was generally higher than interobserver agreement. Conclusion. Agreement on disk position in the sagittal plane, on presence and amount of joint fluid, and on diagnosis was fair to moderate. Agreement on disk configuration, on disk position in the coronal plane, and on bone marrow changes was poor.

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Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

et al. 2004

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“…One such chronic inflammatory syndrome includes TMD in which NOS and NO have been identified both in the synovial fluid [Takahashi et al, 1996[Takahashi et al, , 1999Suenaga et al, 2001] and in the synovial tissues of individuals experiencing pain and tissue pathology [Homma et al, 2001]. In this regard, the histopathology associated with TMD, particularly in individuals who have had surgical intervention and disc replacement, includes mononuclear cell infiltrates and the presence of multinucleated giant cells ( fig.…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, a significant correlation has been reported between severity of pain and levels of TNF· in synovial fluid of TMD [Shafer et al, 1994], and TNF· levels were higher in TMD with bony changes [Fu et al, 1995]. Since TNF· is one of multiple inducers of nitric oxide [Bogdan, 2001], it was anticipated and demonstrated that NO was elevated in affected synovial tissues of TMD, as in other arthritides [Homma et al, 2001], and might correlate with joint pain [Suenaga et al, 2001] and/or degenerative changes [Takahashi et al, 1996[Takahashi et al, , 1999. Disruption of the inflammatory cascade with nonsteroidal anti-inflammatory agents (NSAIDs), cyclooxygenase 2 (COX2)-selective inhibitors, and/or surgical intervention, which may include repair, removal or replacement of the intra-articular disc have had limited success [Ta et al, 2002].…”

Section: Introductionmentioning

confidence: 99%

Nitric Oxide in Experimental Joint Inflammation

Wahl

McCartney-Francis

Chan

et al. 2003

Cells Tissues Organs

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The host response to infection or injury initiates a cascade of events involving recruitment of leukocytes and the release of multiple inflammatory mediators. One of these mediators, nitric oxide (NO), not only represents an important microbicidal agent in host defense, but also functions as a biological signaling and effector molecule in inflammation and immunity. However, overproduction of NO can be autotoxic and contribute to tissue damage and has been implicated in pathogenesis of tumors, and infectious, autoimmune and chronic degenerative diseases. NO is generated via constitutive and inducible nitric oxide synthases (iNOS) which catalyze the oxidation of a guanidino nitrogen associated with L-arginine. Whereas endothelial NOS (eNOS) and neuronal NOS (nNOS) are constitutively expressed, iNOS is transcriptionally induced by bacterial constituents and inflammatory mediators, including TNFα and IL-1. In an experimental model of bacterial component-induced joint inflammation and tissue degradation, functionally distinct roles of the constitutive NOS and iNOS were demonstrated. Following systemic delivery of an arthritogenic dose of streptococcal cell walls (SCW), these bacterial peptidoglycan-polysaccharide complexes disseminate and target the peripheral joints, liver and spleen of the treated animals. Following deposition of the SCW in the peripheral joints, an initial innate inflammatory response to the bacterial components progresses into an adaptive immune response with the recruitment and activation of mononuclear phagocytes and T lymphocytes. With the release of cytokines and inflammatory mediators, there is an upregulation of gene expression for iNOS, but not the constitutive nNOS or eNOS. Nonetheless, the constitutive NOS isoforms, regulated by calcium fluxes and interaction with calmodulin, may also enhance NO production. Increased release of NO was detected not only in the synovium, but also in the circulation, and plasma levels of nitrate plus nitrite, the stable products of NO reactions, correlated with disease progression. Following inhibition of NO production with nonspecific NOS inhibitors, such as N^G-monomethyl-L-arginine, which target all three isoforms, there is a striking therapeutic benefit with reduced signs and symptoms of erosive arthritis. In contrast, selective targeting of iNOS with N-iminoethyl-L-lysine resulted in exacerbation of the synovial inflammation and degradation of joint structures. Based on these data, it appears that the constitutive isoforms of NOS contribute to the pathophysiology of the arthropathy, and that induced NOS and NO may function, in part, in a protective pathway. Moreover, the suppression of NO following treatment with TNFα antagonists results in reduced inflammation and the associated synovial pathology. Collectively, these data implicate discrete roles for the NOS isoforms in the emergence of local tissue pathology and underscore the need to define the specific pathways that are being targeted for interventional strategies.

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“…Effusionen zeigen sich zumeist im lateralen Gelenkbereich und im anterosuperioren Gelenkraum mit einer prozentualen Häufigkeit im Patientenkollektiv um 20%, wobei aber auch Angaben von 13 und 88% vorliegen [4,12,41 69,95,97]. Inwiefern Effusionszeichen Ausdruck eines entzündlichen und/oder degenerativ-arthrotischen Vorgangs im Gelenkbinnenraum oder lediglich einer Ansammlung (vermehrter) Gelenkflüssigkeit sind, ist derzeit noch nicht abschließend geklärt [28,69,99,108].…”

Section: Effusionunclassified

“…bilateralen schmerzhaften Diskusverlagerungen ohne Reposition und klinisch assoziierter Hypomobilität verglich, stützen die Annahme, dass eine deutliche Ausprä-gung der Gelenkeffusion im Kernspintomogramm mit Synovitis verbunden ist [94]. Die zusätzliche intravenöse Applikation von Kontrastmittel (Gadolinium-DTPA) und der anschließende kernspintomographische Vergleich vor und nach Bolusinjektion sollen schmerzhafte Gelenke deutlich besser von nicht schmerzhaften Gelenken diskriminieren [97].…”

Section: Effusionunclassified

Bildgebende Diagnostik bei Schmerzsymptomatik im Kiefergelenkbereich

Hugger

2002

Schmerz

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In the literature there exist some references to and indications for an association between TMJ pain and structure-based findings on TMJ images, i.e. morphology of the condyle, condyle-fossa relationship, form and position of the disc, signs of effusion of the upper resp. lower joint compartment, bone marrow signal abnormalities of the condyle, signal characteristics of the retrodiscal tissue. Despite some hints the relation between TMJ pain and so-called abnormalities on TMJ images remains unclear, complex and little predictive in individual cases.

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Temporomandibular disorders: relationship between joint pain and effusion and nitric oxide concentration in the joint fluid.

Abstract: Painful joints are more likely to demonstrate contrast enhancement of joint effusion. Nitric oxide concentration in TMJ fluid is closely associated with inflammatory changes and painful TM joints.

Cited by 40 publications

References 30 publications

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

Magnetic resonance imaging of the temporomandibular joint: a study of inter- and intraobserver agreement

Nitric Oxide in Experimental Joint Inflammation

Bildgebende Diagnostik bei Schmerzsymptomatik im Kiefergelenkbereich

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