Clinical signs of craniomandibular disorders in patients with psoriatic arthritis

Könönen, Mauno

doi:10.1111/j.1600-0722.1987.tb01851.x

Cited by 12 publications

(30 citation statements)

References 11 publications

(10 reference statements)

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“…However, some studies have suggested that dysfunction occurs in 90% patients with PA (4,5). More recently, Dervis and Dervis (3) found the TMJ to be symptomatic in 29% and 35% of patients with psoriasis and PA, respectively.…”

Section: Psoriatic Arthropathy Of the Temporomandibular Jointmentioning

confidence: 99%

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

O’Connor¹,

Fawthrop

Salha

et al. 2017

Eur J Rheumatol

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IntroductionThe incidence of temporomandibular joint (TMJ) involvement in inflammatory arthritis is often underestimated, and experience in treatment among rheumatologists is limited. Three conditions have an affinity toward the TMJ: Rheumatoid arthritis (RA), psoriatic arthritis (PA), and ankylosing spondylitis (AS). The prevalence is the highest in RA, followed by PA (1-5).The disease processes differ from those seen in osteoarthritis or following trauma, which are characterized by degeneration or ankylosis, respectively, as joint destruction occurs. Furthermore, inflammatory arthropathies are systemic diseases that can lead to a relapse in symptoms, despite initially successful treatment, as TMJ inflammation continues. Immunosuppressive therapies used to ameliorate systemic inflammation may also complicate treatment responses, particularly if surgical management is required, as there is a theoretical increased risk of infection. In contrast, osteoarthritis symptoms may stabilize, previous joint trauma tends not to deteriorate unless TMJ ankylosis ensues, and immunosuppression is not required. Therefore, a different management approach is required in patients with inflammatory arthropathy that addresses both the systemic illness and localized TMJ disease.Pain, reduced mouth opening, joint noises, locking, and difficulty eating are the predominant symptoms and can be debilitating if left untreated. Pain originates from the TMJ itself, the associated masticatory muscles, or from both these areas, and it is manifested by tenderness on palpation of the respective anatomical area. Mouth opening is measured as the gap between the tips of the upper and lower incisors at maximal opening (interincisal distance) with less than 35 mm considered abnormal (6). Joint noises and locking result from the internal derangement of the joint mechanism, which consists of the mandibular condyle, intra-articular disc, and glenoid fossa, or from inflammatory debris deposited as part of the disease process. Combined with pain and restricted opening, these contribute toward problems in eating. 151Many conditions may affect the temporomandibular joint (TMJ), but its incidence in individual joint diseases is low. However, inflammatory arthropathies, particularly rheumatoid and psoriatic arthritis and ankylosing spondylitis, appear to have a propensity for affecting the joint. Symptoms include pain, restriction in mouth opening, locking, and noises, which together can lead to significant impairment. Jaw rest, a soft diet, a bite splint, and medical therapy, including disease-modifying antirheumatic drugs (DMARDs) and simple analgesia, are the bedrock of initial treatment and will improve most symptoms in most patients. Symptom deterioration does not necessarily follow disease progression, but when it does, TMJ arthroscopy and arthrocentesis can help modulate pain, increase mouth opening, and relieve locking. These minimally invasive procedures have few complications and can be repeated. Operations to repair or remove a damaged in...

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Section: Psoriatic Arthropathy Of the Temporomandibular Jointmentioning

confidence: 99%

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

O’Connor¹,

Fawthrop

Salha

et al. 2017

Eur J Rheumatol

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“…To date, only about 35 reported cases of PA affecting the TMJ have been reported in the literature (Table 1) (17–28). However, Könönen have investigated the subjective, clinical, and radiographic features of temporomandibular disorders (TMD) in patients with PA and have reported that involvement of the TMD may be common (29–32).…”

Section: Introductionmentioning

confidence: 99%

The prevalence of temporomandibular disorders in patients with psoriasis with or without psoriatic arthritis

Derviş

2005

J of Oral Rehabilitation

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Psoriasis is a chronic, genetic, non-contagious skin disorder that appears in many different forms and can affect any part of the body, including the nails and scalp. It may affect the quality of life by causing psychosocial stress. Psoriatic arthritis (PA) is considered to be a spondyloarthropathy, and has spinal and peripheral joint involvement associated with psoriasis. The purpose of this study was to evaluate the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with psoriasis without PA and in patients with PA and compare with a healthy group. Signs and symptoms of TMD were evaluated by means of Helkimo's Anamnestic (Ai) and Dysfunction indices (Di). In the present study, patients with psoriasis without arthritis did not report TMD signs and symptoms significantly more often than healthy subjects. A statistically significant increase was found in patients with PA when compared with psoriasis patients without arthritis and healthy patients in Di. In patients with PA, muscle tenderness on palpation, temporomandibular joint sounds and stiffness/tiredness in jaws in the morning were the most frequent findings. It is concluded that the signs and symptoms of TMD in PA is caused mainly by related joint involvement that directly affects the masticatory system.

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“…The last-mentioned patient also had the only posterior surface erosion of the condyle. In psoriasis patients, however, especially posterior palpation of the TMJ may be diagnostically difficult because of the frequent occurrence of skin lesions in the external auditory meatus (5).…”

Section: Discussionmentioning

confidence: 99%

Craniomandibular disorders in psoriatic arthritis: Correlations between subjective symptoms, clinical signs, and radiographic changes

Könönen

1986

Acta Odontologica Scandinavica

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One hundred and ten patients with psoriatic arthritis (PA group) and 110 individually matched control subjects (C group) without general joint or skin disease were studied to determine correlations between radiographic changes, detected on orthopantomography, in the condyle of the temporomandibular joint and subjective symptoms and clinical signs of craniomandibular (CM) disorders. In the PA group there was a correlation, not found in the C group, between the radiographic changes, especially erosions, and subjective symptoms and clinical signs of CM disorders. The correlations found indicate that in PA subjective symptoms, clinical signs, and radiographic changes in the stomatognathic system are mainly caused by the systemic joint disease.

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Clinical signs of craniomandibular disorders in patients with psoriatic arthritis

Cited by 12 publications

References 11 publications

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures

The prevalence of temporomandibular disorders in patients with psoriasis with or without psoriatic arthritis

Craniomandibular disorders in psoriatic arthritis: Correlations between subjective symptoms, clinical signs, and radiographic changes

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