The occurrence of antibodies against chlamydia species in patients with monoarthritis and chronic closed lock of the temporomandibular joint

Infectious arthritis and the temporomandibular joint. A review

OBJECTIVE

Microorganisms can cause acute infectious arthritis, chronic infectious arthritis, or reactive inflammatory arthritis. The aim of this study is to perform a narrative review of the pathophysiology, etiology, and diagnostic features of infectious arthritis and TMJ infectious arthritis.

METHODS

A search of the literature was performed using Medline, Scielo, Embase, and Google Scholar databases. The terms employed for the search were "Temporomandibular Joint Disorders" and "Infectious Arthritis"; or "Septic Arthritis"; or "Bacterial, Fungal, or Viral Arthritis." Over three hundred articles were screened for eligibility.

RESULTS

The selected articles were utilized to perform a narrative review of the general aspects of infectious arthritis and infectious arthritis affecting the TMJ.

CONCLUSION

Infectious arthritis is a rare, yet very morbid, form of arthritis. Understanding general aspects of joint infections and specific features of TMJ infectious arthritis is imperative for an adequate diagnosis.

Reactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study

The aim of this study was to find out if reactive arthritis was involved in the aetiology of chronic closed lock of the temporomandibular joint (TMJ) by looking for bacterial antigens in the synovial membrane of the TMJ, and by studying the antibody serology and carriage of human leucocyte antigen (HLA) B27 in patients with chronic closed lock. Patients with reciprocal clicking and healthy subjects acted as controls. We studied a total of 43 consecutive patients, 15 with chronic closed lock, 13 with reciprocal clicking, and 15 healthy controls with no internal derangements of the TMJ. Venous blood samples were collected from all subjects for measurement of concentrations of HLA tissue antigen and serology against Chlamydia trachomatis, Yersinia enterocolitica, Salmonella spp., Campylobacter jejuni, and Mycoplasma pneumoniae. Samples of synovial tissue from patients with closed lock and reciprocal clicking were obtained during discectomy and divided into two pieces, the first of which was tested by strand displacement amplification for the presence of C trachomatis, and the second of which was analysed for the presence of species-specific bacterial DNA using 16s rRNA pan-polymerase chain reaction (PCR). There were no significant differences between the groups in the incidence of antibodies against M pneumoniae, Salmonella spp. or Y enterocolitica. No patient had antibodies towards C trachomatis or C jejuni. We found no bacterial DNA in the synovial fluid from any patient. The HLA B27 antigen was present in 2/15 subjects in both the closed lock and control groups, and none in the reciprocal clicking group. In conclusion, reactive arthritis does not seem to be the mechanism of internal derangement of the TMJ.

Current diagnosis of temporomandibular pathologies

The current scientific knowledge of TMJ pathologies points to the importance of etiological research and the need for differential diagnosis using the most modem technological resources. Those include MRI, computed tomography, serologic studies, genetic mapping, and bioelectronic instruments which allow clinicians to study, understand, and measure respectively, the structural changes of soft and hard tissues, infections, genetic susceptibility for autoimmune diseases, and stomatognathic function. The purpose of this article is an overview of the current knowledge and related tools for the diagnosis of TMJ pathologies.

Bacterial diversity in synovial fluids of patients with TMD determined by cloning and sequencing analysis of the 16S ribosomal RNA gene

OBJECTIVE

The purpose of this study was to examine the presence of bacteria in synovial fluids from patients with temporomandibular joint disorder (TMD) by polymerase chain reaction (PCR) targeting the 16S ribosomal RNA (rRNA) gene, followed by cloning and sequencing.

STUDY DESIGN

Universal bacterial primers were used to amplify 16S rRNA genes in 28 synovial fluid samples from 27 patients with TMD (TMD group) as well as control subjects: 5 patients with dislocation of TMJ (non-TMD group). Subsequently, PCR amplicons were purified and cloned. Partial 16S rRNA sequences of the cloned insert were used to determine the species identities or closest relative by comparison with known sequences using GeneBank.

RESULTS

Nineteen (67.86%) of 28 samples from patients in the TMD group were identified with the presence of bacterial DNA by PCR. The 5 control samples from the nonTMD group were all negative in this study. After cloning and sequencing, a total of 11 bacterial species was detected, including Granulicatella adiacen (6 samples), Pseudomonas sp. (6 samples), Methylobacterium sp. (5 samples), and Beta proteobacterium (4 samples). Other species, such as Acidovorax sp., Bradyrhizobium sp., Sphingomonas, Streptococcus, Leptothrix sp. oral clone, Thiobacillus denitrificans, and Comamonadaceae bacterium, were also identified. Eight patients were found with mixed bacteria, with 2-4 bacteria per sample. The patients with fastidious bacteria such as Granulicatella adiacen and mixed bacteria were more likely to be older than 45 years (P < .05).

CONCLUSION

A wide variety of bacteria, including some not previously reported associated with TMD, were identified in the synovial fluids from patients with TMD.

Disc derangements of the temporomandibular joint

Disc-related derangement of the temporomandibular joint is common and epidemiological research has found that about 20% of the population may be affected. Although very few of these people have the more prominent symptoms, recent data indicate that the numbers who need treatment is increasing. The two clinical variants of disc derangement, reciprocal clicking and closed lock, have long been recognized, but the association between them and their aetiology and pathogenesis is still unclear. As a consequence, there is still uncertainty on how to treat the conditions, and this is even more evident when surgery is involved. This paper describes new tissue research related to disc derangement. A simplified scheme is presented and implications for surgical treatment are discussed.