Psoriatic arthritis of the temporomandibular joint – a surgical alternative to treating a medical problem

Abstract

We describe the case of a 43‐year‐old female who suffered pain and profound functional impairment in both tempormandibular joints (TMJ), secondary to psoriatic arthritis. The inability to eat and talk without severe pain had rendered the patient unable to seek employment and with a poor quality of life. Her symptoms had proved refractory to anti‐TNF medication (Etanercept) and other treatments such as hydrocortisone injections and bilateral TMJ condylar shaves. The patient underwent bilateral total temporomandibular joint (TMJ) replacements in May 2008. Her recovery was uneventful and she is now pain‐free and has a vastly improved quality of life. This case gives an overview of psoriatic arthritis, especially as it affects the TMJ and highlights the benefits of total TMJ replacement. We recommend that consideration should be given to its use as a surgical alternative in cases which prove refractory to medical management.

Psoriatic arthritis of the temporomandibular joint: A systematic review

“…evolution ranged between 1.5 years and 24 years, with three cases having an over 20-year period evolution: 20 years, 14 21 years 18 and 24 years. 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.…”

“…18,22,23 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][19][20][21][22][23]25…”

“…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.…”

“…38 Preceding surgical treatments included discectomy, TMJ arthroscopy, condylar shave or total joint replacement. 35 As surgical methods were performed: intra-articular infliximab administration, 23 TMJ condylar shave, bilateral total TMJ replacement, 19 surgical treatment of the removal of the ankylotic block and subsequent arthroplasty, 38 condylotomy. 25 Orthodontic and prosthetic rehabilitation along with stabilisation appliances were used.…”

Diagnosing psoriatic arthritis of the temporomandibular joint: a study in radiographic images

“…The diagnosis is based on the presence of the triad of: (1) psoriasis, (2) erosive polyarthritis and (3) negative serological test for rheumatoid factor 2. In case of the TMJ, the radiological presentation of the arthritis is in the form of erosion and resorption of the mandibular condyles with spicules of calcification and osteophytic spurs in the joint space 2 3. In this report we present CT scans and skull x-ray of a case of PA.…”