Osseous changes in the temporomandibular joint in rheumatoid arthritis: A cone-beam computed tomography study

Abstract

PurposeTo evaluate osseous changes of temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA) using cone-beam computed tomography (CBCT) and to correlate the imaging findings with the severity of TMJ dysfunction, clinical findings, and laboratory findings.Materials and MethodsThis study consisted of 28 subjects, including 14 RA patients and 14 controls, who were scheduled to undergo CBCT imaging for the diagnosis of a complaint not related to or affecting the TMJ. The Fonseca's questionnaire was used to assess the severity of TMJ dysfunction. Rheumatoid factor (RF) and the erythrocyte sedimentation rate (ESR) were assessed in the RA patients. CBCT was then performed in all subjects and osseous TMJ abnormalities were assessed.ResultsAccording to the Fonseca's questionnaire, 14.3% of the patients had no TMJ dysfunction, while 50%, 21.4%, and 14.3% had mild, moderate, and severe dysfunction, respectively. RF was positive in 64.3% of patients, and the ESR level was high in 100%. Imaging findings revealed a statistically significantly higher prevalence of erosion (85.7%), flattening (89.3%), osteophyte formation (32.1%), subchondral cyst (32.1%), sclerosis (64.3%), and condylar irregularities (28.6%) in the RA patients than in the controls. No correlations were found between CBCT findings and the clinical findings, the severity of TMJ dysfunction, disease duration, or laboratory results.ConclusionRA patients might show extensive osseous abnormalities with no/mild clinical signs or symptoms of TMJ dysfunction that necessitate TMJ imaging for these patients. CBCT is a valuable and efficient modality that can assess osseous TMJ changes in RA patients.

Increased Risk of Temporomandibular Joint Disorder in Patients with Rheumatoid Arthritis: A Longitudinal Follow-Up Study

“…TMJ pain could have a negative effect on the normal activities and quality of life in patients with RA [45,46]. These findings were similar to those of previous studies, in which degenerative bone changes were observed on radiographic or magnetic resonance imaging, in patients with TMJ and RA (MRI) [47][48][49]. Meanwhile, Uchiyama et al demonstrated that the incidence of bony deformation in the mandibular condyle was not related to the duration of RA or changes in the other joints [50].…”

The Roles of Indian Hedgehog Signaling in TMJ Formation

“…Compared to the development of OA in synovial joints of appendicular skeletal elements, the prevalence of osteophyte formation in TMJ OA is relatively rare. However, once developed, it causes various clinical symptoms and subsequently compromises joint function [92]. While Transforming growth factor β (TGFβ), Bone morphogenetic proteins (BMPs), Fibroblast growth factors (FGFs), or insulin-like growth factor-1 (IGF-1) have been detected in the developing osteophyte [93][94][95][96][97], what causes osteophytes in TMJs remains obscure.…”

Temporomandibular joint damage in K/BxN arthritic mice

“…TMJ cartilage damage was, however, less pronounced than that seen in the knee joints, as evidenced by μCT. Many authors have reported that X-ray imaging and especially CBCT is a very effective technique for characterizing TMJ osteoarthritis in humans, [15][16][17] and several criteria have been defined: (i) erosion with an interruption or absence of cortical lining, (ii) sclerosis with increased density of cortical lining or subchondral bone, (iii) osteophytes with marginal bone outgrowth, (iv) geodes or subchondral cysts with single or multiple pyriform-shaped subchondral lesions with sclerotic margins, and (v) joint space narrowing. 28 In this study, we also examined the deeper cartilage layers, such as the fibrocartilage layer, which is schematically subdivided into proliferative and hypertrophic areas.…”

“…1,13,14 The dose of X-ray delivered during CBCT is low, which is advantageous for exploring TMJ in children, and enables high spatial resolution with limited irradiation levels. [15][16][17][18] The advantage of CBCT is the visualization of dense structures, such as the temporal bone and mandibular condyle, in three dimensions. Magnetic resonance imaging seems to be the most relevant imaging modality for assessing TMJ osteoarthritis, as early changes can be detected, and both hard and soft tissues and even joint fluid can be visualized.…”