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Clinical, ultrasonographic and multidetector computed tomography features of temporomandibular joint in rheumatoid arthritis and psoriasis patients

Fatma Ali, Shereen R Kamel, Hanaa Ahmed Sadak, Asmaa Kotb Mohamed, Manal F Abu samara & Moustafa Abdelkader

Background: The incidence of Tempro Mandibular Joint (TMJ) involvement in inflammatory arthritis is underestimated. It is more common in Rheumatoid Arthritis (RA) than in Psoriatic Arthritis (PsA). TMJ affection could presented by headache, pain, click difficulty in mouth opening. Different imaging modalities disclose TMJ; conventional radiography, musculoskeletal ultrasound (MSUS), Multi Detector Computed Tomography (MDCT) and Magnetic resonance imaging Due to variability of the complaints, Temporo Mandibular Disorder (TMD) is diagnosed mainly by signs and symptoms. As there are no criteria to attain a numeric value to decide the severity of TMD, indices play an important role to determine the prevalence of this disorder in a specified population. Patients and methods: 75 patients were enrolled; 50 RA according to ACR/EULAR criteria and 25 PsA according to Caspar criteria. TMJ questionnaire was assessed according to Helkimo score. Also MSUS and MDCT scores were done. Results: Clinical TMJ affection was found in 42 RA and in 10 psoriasis patients. According to Helkimo score 84% of RA and 40% of PsA were found. By MSUS 72% of RA patients and 32% of PSA patients were affected. By MDCT 66% of RA patients and only 3% of PsA patients were noticed. There were positive correlation between duration of illness and disc displacement (r=0.4, P=0.0008) and also between morning stiffness with osteophyte and effusion (r=0.3,p=0.03, r=0.4,p=0.01). In PSA there were positive correlations between tender swollen joints with US effusion and erosion (r=0.5 P=0.01, r=0.6 p=0.002, r=0.5 p=0.006, r=0.5 p=0.006) respectively In RA patients, RF positivity was positively correlated with MDCT of impaired mouth opening (r=0.3, p=0.04), and Anti-CCP positivity was positively correlated with MDCT of increased joint space (r=0.4, p=0.01). Conclusion: There was correlation between severity of TMJ dysfunction and disease activity as well as severity in RA and PSA.