ISSN 2147-9720 | E-ISSN 2148-4279
Literature Review
Management of the temporomandibular joint in inflammatory arthritis: Involvement of surgical procedures
1 Department of Oral and Maxillofacial Surgery, Derby Hospitals NHS Foundation Trust, Derby, UK  
2 Department of Rheumatology, Rotherham NHS Foundation Trust, Rotherham, UK  
3 Department of Oral and Maxillofacial Surgery, University of Leicester Hospitals NHS Trust, Leicester, UK  
4 Department of Oral and Maxillofacial Surgery, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK  
Eur J Rheumatol 2017; 4: 151-156
DOI: 10.5152/eurjrheum.2016.035
This article was viewed 796 times, downloaded 666 times

Key Words: Temporomandibular joint, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, arthroscopy, joint replacement
Abstract

Many 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 intra-articular disc or to refine joint anatomy are used in select cases. Total TMJ replacement is reserved for patients where joint collapse or fusion has occurred or in whom other treatments have failed to provide adequate symptomatic control. It yields excellent outcomes and is approved by the National Institute of Health and Care Excellence (NICE), UK. Knowledge of the assessment and treatment of the TMJ, which differs from other joints affected by inflammatory arthritis due to its unique anatomy and function, is not widespread outside of the field of oral and maxillofacial surgery. The aim of this article is to highlight the peculiarities of TMJ disease secondary to rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis and how to best manage these ailments, which should help guide when referral to a specialist TMJ surgeon is appropriate.

Key Words
Authors
All
Author’s Corner
Survey
AVES | Copyright © 2017 Medical Research and Education Association | Latest Update: 15.09.2017