Temporomandibular joint dysfunction in some rheumatological diseases (case–control study)

Abstract

Background The incidence of temporomandibular joint (TMJ) involvement in inflammatory arthritis, such as rheumatoid arthritis, is often underestimated. Noninvasive imaging modalities such as musculoskeletal ultrasound (MSUS) are used to evaluate the TMJ. Aim This study was conducted to determine the affection of TMJ in some rheumatological diseases using MSUS. Patients and methods The study included 50 participants divided into two groups: group I included 40 patients (80 TMJ joints) with four rheumatological diseases, and group II included 10 apparently healthy persons (20 TMJ joints) matched in age and sex with the patients, chosen as a control group. All patients were diagnosed clinically and through laboratory investigations. Thereafter, they were assessed for pain degree by visual analog scale (VAS); disease activity using disease activity score-28, systemic lupus erythematosus disease activity index, and Western Ontario and McMaster Universities Arthritis Index; functionally using Modified Health Assessment Questionnaire, and Fonseca questionnaire; and underwent imaging assessment using panoramic radiography and musculoskeletal ultrasonography. Results Erosions were detected in 12.5% of the examined TMJs by panoramic radiography, whereas they were detected in 32.5% by MSUS. TMJ effusion and disc displacement could not be detected by panoramic radiography, whereas effusion was detected by MSUS in 23.8% of the examined TMJs and disc displacement was detected in 27.5%. Conclusion MSUS is more sensitive in detection of TMJ affection than panorama x-ray. Radiographic pathological findings by MSUS and panorama x-rays were more in temporomandibular joint disorders of patients with rheumatoid arthritis followed by systemic lupus erythematosus and then osteoarthritis, and finally, psoriatic arthritis.