Reactive arthritis: preliminary microbiologic analysis of the human temporomandibular joint

Reconstruction of the TMJ and condyle in inflammatory arthritis

Inflammatory arthritis presents a unique destructive process to the temporomandibular joint. This article provides information on the proper diagnosis, treatment planning, and surgical management aimed to provide patients with improvement in pain, function, stability and facial aesthetics. Additionally, it aims to provide a detailed insight on the joint reconstruction options including alloplastic joint replacement, autogenous joint replacement, orthognathic surgery and distraction osteogenesis.

Mycoplasma genitalium: A new superbug

Mycoplasma genitalium (MG) is an emerging sexually transmitted pathogen. It is an important cause of nongonococcal urethritis in men and is associated with cervicitis and pelvic inflammatory disease in women, putting them at risk of infertility. Multiple factors that aid pathogenesis of MG include its ability of adhesion, gliding motility, and intracellular invasion by means of the tip organelle. Through intracellular localization and antigenic variation, MG could result in treatment-resistant chronic infection. There are limited data on the prevalence of MG in Indian patients with urogenital syndromes. Recently, a high prevalence of extra genital infection with MG has been reported. Molecular assays are the major diagnostic techniques of MG infection. Antimicrobial agents such as macrolides, along with fluoroquinolones, are the treatment of choice for MG infections. The issue of drug resistance to azithromycin and fluoroquinolones in MG is rising globally. As molecular tests are becoming available for MG, both for the diagnosis and the detection of antimicrobial resistance, any patient with MG infection should then be tested for antimicrobial resistance. Consideration of MG as a cause of sexually transmitted disease in the Indian population is crucial in diagnostic algorithms and treatment strategies. The purpose of this review is to understand the prevalence of MG in different clinical scenarios, molecular mechanisms of pathogenesis, current status of antimicrobial resistance, and its impact on MG treatment.

Can Patients With Metal Hypersensitivity Requiring TMJ Total Joint Prostheses be Successfully Treated With All-Titanium Alloy Mandibular Components?

PURPOSE

Patients with documented metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy with trace nickel requiring TMJ total joint prosthesis (TJP) may have adverse reactions to the metals in the standard TMJ Concepts TJP. This study aimed to determine if these patients can be successfully treated by eliminating CoCrMo alloy and constructing the mandibular components of all-titanium (Ti) alloy.

PATIENTS AND METHODS

This retrospective cohort study evaluated metal hypersensitive patients (MHG) that received the TMJ Concepts TJP modification of all-Ti alloy mandibular components with outcome results compared to a control group (CG) of non-metal-sensitive patients that received the standard TMJ Concepts prostheses. The primary predictor variables were the 2 groups, MHG and CG. Primary variables evaluated using Likert scales included TMJ pain, headache, jaw function, diet, and disability. Maximum incisal opening and quality of life were measured. Secondary variables included: age, gender, effect of the number and type of prior TMJ. Scores for pre- and postsurgery parameters (nonparametric variables) were analyzed using a Mann-Whitney U test (α = 0.05).

RESULTS

The MHG (n = 30) received the Ti alloy TJP and CG (n = 46) received the standard TJP, with statistically significant improvements in all variables in both groups and no statistically significant difference in outcome variables between the 2 groups. Patients with 0 to 1 previous TMJ surgeries had better outcomes in all parameters except maximum incisal opening compared to patients with 2 or more previous TMJ surgeries.

CONCLUSIONS

Patients with documented hypersensitivity to CoCrMo alloy, requiring TMJ Concepts TJP may experience improvement in TMJ pain, headache, jaw function, diet, disability, jaw opening, and quality of life when the mandibular components are manufactured from all-Ti alloy, eliminating the CoCrMo alloy. The larger the number of previous TMJ surgeries and exposure to failed alloplastic implants, the less improvement in treatment outcomes.

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.

Chlamydia-Induced Reactive Arthritis: Disappearing Entity or Lack of Research?

PURPOSE OF REVIEW

Recent studies regarding the frequency of Chlamydia-induced reactive arthritis (ReA) are reviewed, with a focus on the question of whether the entity is in fact disappearing or whether it is simply being underdiagnosed/underreported. Epidemiological reports indicate diversity in the frequency of Chlamydia-associated ReA in various parts of the world, with evidence of declining incidence in some regions.

RECENT FINDINGS

The hypothesis that early effective treatment with antibiotics prevents the manifestation of Chlamydia-associated ReA requires further investigation. For clinicians, it is important to remember that ReA secondary to Lymphogranuloma venereum (LGV) serovars L1-L3 of C. trachomatis is probably underestimated due to a limited awareness of this condition, the re-emergence in Western countries of LGV overall, and the present increasingly rare classical inguinal presentation.

Anterior open bite due to idiopathic condylar resorption during orthodontic retention of a Class II Division 1 malocclusion

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.

Microbiological investigation of the mandibular condyle in patients with advanced osteoarthritis of the temporomandibular joint

PURPOSE

The aim of this study was to investigate the presence of bacteria in samples of the temporomandibular joint taken from patients suffering from advanced osteoarthritis of the temporomandibular joint (TMJ).

MATERIALS AND METHODS

25 fresh mandibular condyle samples were taken from 17 consecutive patients undergoing mandibular condylectomy (8 bilateral) for advanced TMJ osteoarthritis (Dimitroulis Category 5 joints). The joint samples were stained and cultured for the presence of microorganisms following a standardised joint culture protocol.

RESULTS

No evidence of bacteria was found on staining or solid culture mediums. Late growth (day 12) of commensal skin organisms (P. Acnes, S. Epidermitis, S. Capitis) were identified in enriched broth samples in 5 joint samples. No statistically significant associations were noted between positive broth samples and age or previous joint intervention (p > 0.05) CONCLUSIONS: Within the limitations of this study, we have failed to identify meaningful bacterial growth in tissues (i.e. condylar head) of the TMJ that would suggest a contributory bacterial pathogenesis for arthritis of the TMJ.

Association of bone marrow edema with temporomandibular joint (TMJ) osteoarthritis and internal derangements

PURPOSE

This study reviewed the dental literature in order to determine the association of bone marrow edema with osteoarthritis and temporomandibular joint (TMJ) internal derangement disorders.

METHODS

A literature search was performed using electronic databases PubMed/Medline (National Library of Medicine, Bethesda, Maryland) and Cochrane for articles published during the last 15 years (January 2000-December 2014). A predetermined inclusion and exclusion criteria were used for filtering the scientific papers. Research articles fulfilling the basic inclusion criteria were included in the review.

RESULTS

The reviewed studies showed that bone marrow edema is found in painful joints with osteoarthritis in a majority of cases. A few cases with no pain or significant degenerative changes are reported to have a bone marrow edema pattern as well.

CONCLUSIONS

Bone marrow edema, increased fluid level, and pain are associated with osteoarthritis in the majority of patients reporting TMJ arthritis. Degenerative and disc displacement conditions are multifactorial and require further investigations. Magnetic resonance imaging can be employed to detect bone marrow edema even in the absence of pain and clinical symptoms in the patients of internal derangements.

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.

Can orthodontic relapse be blamed on the temporomandibular joint?

There are many temporomandibular joint (TMJ) conditions that can cause orthodontic treatment instability and relapse. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc., Many of these TMJ conditions can cause progressive and continuous changes in the occlusion and jaw relationships. Patients with these conditions may benefit from corrective orthodontic and surgical intervention. The difficulty for many clinicians may lie in identifying the presence of a TMJ condition, diagnosing the specific TMJ pathology, and selecting the proper treatment for that condition. This paper will discuss the most common TMJ pathologies that can adversely affect orthodontic stability and outcomes as well as present the treatment considerations to correct the specific TMJ conditions and associated jaw deformities to provide stable and predictable treatment results.

Septic arthritis of the temporomandibular joint: case reports and review of the literature

BACKGROUND

Septic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity.

OBJECTIVE

We reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency physicians.

CASE REPORTS

In the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned 1 mL of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharged home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than 3 weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later she underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; 20 months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint.

CONCLUSION

Septic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.

Mycoplasma genitalium: from Chrysalis to multicolored butterfly

The history, replication, genetics, characteristics (both biological and physical), and factors involved in the pathogenesis of Mycoplasma genitalium are presented. The latter factors include adhesion, the influence of hormones, motility, possible toxin production, and immunological responses. The preferred site of colonization, together with current detection procedures, mainly by PCR technology, is discussed. The relationships between M. genitalium and various diseases are highlighted. These diseases include acute and chronic nongonococcal urethritis, balanoposthitis, chronic prostatitis, and acute epididymitis in men and urethritis, bacterial vaginosis, vaginitis, cervicitis, pelvic inflammatory disease, and reproductive disease in women. A causative relationship, or otherwise strong association, between several of these diseases and M. genitalium is apparent, and the extent of this, on a subjective basis, is presented; also provided is a comparison between M. genitalium and two other genital tract-orientated mollicutes, namely, Mycoplasma hominis, the first mycoplasma of human origin to be discovered, and Ureaplasma species. Also discussed is the relationship between M. genitalium and infertility and also arthritis in both men and women, as is infection in homosexual and immunodeficient patients. Decreased immunity, as in HIV infections, may enhance mycoplasmal detection and increase disease severity. Finally, aspects of the antimicrobial susceptibility and resistance of M. genitalium, together with the treatment and possible prevention of mycoplasmal disease, are discussed.

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.

Clinical indications for simultaneous TMJ and orthognathic surgery

There are many temporomandibular joint (TMJ) conditions that can cause pain, TMJ and jaw dysfunction, and disability. The most common of these conditions include: (1) articular disk dislocation; (2) reactive arthritis; (3) adolescent internal condylar resorption; (4) condylar hyperplasia; (5) osteochondroma or osteoma; and (6) end-stage TMJ pathology. These conditions are often associated with dentofacial deformities, malocclusion, TMJ pain, headaches, myofascial pain, TMJ and jaw functional impairment, ear symptoms, etc. Patients with these conditions may benefit from corrective surgical intervention. Open joint surgery provides direct access to the TMJ allowing manipulation, repair, removal and/or reconstruction of the anatomical structures that cannot be accomplished by other treatment methods. TMJ surgery and orthognathic surgery can be predictably performed during one operation with high success rates. This paper discusses the most common TMJ pathologies and presents the surgical management considerations to correct the specific TMJ conditions and associated jaw deformities.

Reactive arthritis of the temporomandibular joints and cervical spine in a child

BACKGROUND

Temporomandibular joint (TMJ) arthritis is frequently seen in children with chronic arthritis. It has rarely been described in a non-infectious acute setting. We report a case of reactive arthritis isolated to the TMJs and cervical spine.

CASE PRESENTATION

A 6-year-old Native American boy hospitalized for treatment of lymphadenitis and aseptic meningitis had an incidental brain magnetic resonance imaging (MRI) finding of effusions in the TMJs, as well as the atlanto-occipital and C1-C2 articulations. Repeat TMJ and cervical spine MRI four weeks later showed resolution of effusions. Reactive TMJ arthritis has been previously reported in adults but not in children.

CONCLUSION

This report represents the first pediatric case of reactive arthritis isolated to the cervical spine and TMJs. Arthritis of the TMJ should be considered in the differential diagnosis of children with reactive arthritides.

Cervical spine and temporomandibular joint arthritis in a child with Kawasaki disease

Severe neck pain, stiffness, and torticollis in a child with Kawasaki disease commonly represent aseptic meningitis or lymphadenitis. Here we present an unusual case of severe cervical spine and bilateral temporomandibular joint arthritis in a 5-year-old boy with a relapse of Kawasaki disease and coronary artery ectasia. The patient had a favorable response to a second course of intravenous immunoglobulin G and indomethacin therapy, with complete resolution of his symptoms.

Statistical correlation between pharyngitis and temporomandibular joint disease

OBJECTIVE

The objective of this study was to evaluate the upper respiratory infection (URI) as an aggravating factor in the established temporomandibular joint (TMJ) disease.

PATIENTS AND METHODS

Four hundred seventeen patients suffering from temporomandibular disorder (TMD) were selected and investigated by means of questionnaires and clinical examinations. After excluding the patients with only muscle disorders, 283 patients were included for the association study between TMJ disease and infectious conditions. The screened infectious conditions were otitis media, maxillary sinusitis/rhinitis, and pharyngitis/tonsillitis. The chi-square test was used to determine the association between variables and stepwise logistical regression was then used.

RESULTS

The prevalence of maxillary sinusitis/rhinitis in TMD patients was 7.0%. The patients who had mouth-opening limitation were 9.93 times more likely to have maxillary sinusitis/rhinitis than those without ( P = .0004). The prevalence of tonsillitis/pharyngitis in TMD patients was 9.1%. The patients who had mouth-opening limitation were 3.50 times more likely to have tonsillitis/pharyngitis than those without it ( P = .0028). The patients who had TMJ capsulitis were 3.91 times more likely to have tonsillitis/pharyngitis than those without it ( P = .0028).

CONCLUSION

The conclusion is made that pharyngitis/sinusitis is significantly associated with some clinical symptoms of TMD. The infection of closely related anatomical structures with TMJ may have an influence on TMJ symptoms. Thus, pharyngitis/sinusitis in the established TMD patients can be a significant warning sign for TMJ symptoms to appear shortly thereafter.

Hematogenous infection of the human temporomandibular joint

Objective This study was designed to discover the relationship between bacteremia and the presence of specific bacterial species in the synovial fluid of the human temporomandibular joint (TMJ). Study design Sixteen volunteers (female to male, 1:2.2; average age, 30.00 +/- 9.93 years) who received operations via intraoral incision participated in this study. Samples from the blood and TMJ synovial fluid of the patients were taken preoperatively and postoperatively and analyzed by PCR assays with specific primers for the clinically important bacteria Staphylococcus aureus , Streptococcus mitis , and beta-hemolytic Streptococcus . Results PCR-based assays revealed the occurrence of S aureus in 68.8% and 50% of the total blood and synovial fluid samples collected immediately after the operations, which statistically differed from the preoperative samples ( P < .05). However, the frequency of the other bacteria, S mitis and beta-hemolytic Streptococcus , in pre- and postoperative blood samples had no such a difference ( P > .05). The chi-square test showed a significant association between the presence of S aureus in the blood and in TMJ synovial fluid (chi 2 = 6.409, P < .05), and the probability of hematogenous infection of the TMJ was estimated as 55.5%. Conclusion Hence, the data obtained provided evidence that the invasion of S aureus into TMJ synovial fluid was due to the presence of these bacteria in the blood. To our knowledge, this is the first report of the bacteremia-related mechanism of S aureus invasion in the human TMJ.

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

PURPOSE

The study goal was to investigate the occurrence of serum antibodies to Chlamydia trachomatis, Chlamydia pneumoniae, and Chlamydia psittaci in patients with temporomandibular joint (TMJ) monoarthritis or chronic closed lock and in control subjects.

PATIENTS AND METHODS

An indirect microimmunofluorescence test for detecting antibodies against C trachomatis was used. Twenty-three patients (12 with monoarthritis and 11 with chronic closed lock) and 42 control subjects were evaluated.

RESULTS

Six patients with monoarthritis, 5 patients with chronic closed lock of the TMJ, and 6 control individuals were considered to have had a past C trachomatis infection based on their immunoglobulin G titers. Corresponding groups for C pneumoniae investigation included 3 patients with monoarthritis, 4 patients with chronic closed lock, and 17 control subjects, and for C psittaci, 1 patient with monoarthritis, 2 patients with chronic closed lock, and 1 control subject. Statistically significant differences between patients and control subjects were found for C trachomatis only; monoarthritis versus control (P =.016), chronic closed lock versus control (P =.038), and all patients versus control (P =.007). Patients with monoarthritis did not differ from patients with chronic closed lock with regard to antibodies against C trachomatis.

CONCLUSION

The occurrence of serum antibodies to C trachomatis was significantly higher in patients than in control subjects, but this occurrence did not correlate with severity of observed tissue changes. Nevertheless, an association may exist between the presence of C trachomatis and TMJ disease.

The presence of bacteria in the synovial fluid of the temporomandibular joint and clinical significance: preliminary study

PURPOSE

The objective of this study was to find any relation between the presence of specific bacterial species in the synovial fluid of the temporomandibular joint (TMJ) and clinical parameters.

PATIENTS AND METHODS

We studied 43 patients (male-to-female ratio, 1:1.69; average age, 34.37 +/- 14.55 years). Thirty-three patients had a displaced disc in the TMJ (DD group), and 10 patients did not have a displaced disc of the TMJ or any symptom related to TMJ disorders (NDD group). Clinical examinations were made to determine maximum mouth opening, joint sounds, previous trauma history, systemic disease, and TMJ pain. Six bacterial species that were reported in other studies were chosen to evaluate the presence of bacteria in the TMJ for this study.

RESULTS

Mycoplasma genitalium was most frequently detected in synovial fluid (86.0%). Staphylococcus aureus, Mycoplasma fermentans/orale, Actinobacillus actinomycetemcomitans, and Streptococcus mitis were detected in 51.2%, 37.2%, 25.6%, and 7.0% of samples, respectively. beta-Hemolytic Streptococcus was not detected. The prevalence of S aureus was significantly higher in the DD group than in the NDD group (P <.05). The patients who had M. fermentans/orale were 5.40 times more likely to be younger than 30 years than were those without M. fermentans/orale (P <.05). Those with M. genitalium were 5.81 times more likely to be female than were those without M. genitalium (P <.05).

CONCLUSION

The presence of S. aureus in TMJ synovial fluid was related to TMJ disorder symptoms and clinical parameters seemed to be influenced by bacterial presence in TMJ synovial fluid.

Comparison of 2 temporomandibular joint total joint prosthesis systems

PURPOSE

The study goal was to evaluate the comparative outcomes of patients treated with temporomandibular joint (TMJ) total joint prostheses, using either the Christensen prosthesis (TMJ Inc, Golden, CO) (CP) or the TMJ Concepts prosthesis (TMJ Concepts Inc, Camarillo, CA; formerly Techmedica Inc) (TP).

PATIENTS AND METHODS

Forty-five consecutive patients treated with either CP or TP total joint prostheses were evaluated. The CP group consisted of 23 patients (40 prostheses; average patient age, 38.8 years). The TP group consisted of 22 patients (38 prostheses; average patient age, 38.5 years). The average number of previous operations for the CP group was 3.9, whereas it was 2.6 for the TP group. The CP and TP groups had an average follow-up of 20.8 and 33.0 months, respectively. Patients were evaluated for incisal opening and occlusal and skeletal stability. A visual analog scale was used for subjective assessment of TMJ pain (0 = no pain, 10 = worst pain), jaw function (0 = normal function, 10 = no function), and diet (0 = no limitations, 10 = liquids only). Statistical analysis was performed using an independent t test, and a value of P <.05 was considered significant.

RESULTS

The average postsurgical incisal opening for the CP group was 30.1 mm (increase of 6.7 mm), and that for the TP group was 37.3 mm (increase of 9.9 mm), indicating significant increase of the TP group (P =.008). The average postsurgical pain level for the CP group was 6.0, a decrease of 1.8, and that for the TP group was 4.1, a decrease of 3.1, indicating significant improvement for the TP group (P =.042). Postsurgical average jaw function for CP was 5.5, an improvement of 1.2. The postsurgical TP average was 3.9, an improvement of 3.0, showing significant improvement for the TP group (P =.008). Average postsurgical diet rating for the CP group was 5.4, an improvement of 1.8. The TP group average was 3.9, an improvement of 2.0, indicating significant improved eating ability for the TP group (P =.021). Skeletal and occlusal stability were good in both groups.

CONCLUSION

The TP group had statistically significant improved outcomes compared with the CP group relative to postsurgical incisal opening, pain, jaw function, and diet. Both groups showed good skeletal and occlusal stability.

Isolation of Chlamydia trachomatis or Ureaplasma urealyticum from the synovial fluid of patients with Reiter's syndrome

BACKGROUND

The aim of this study was to contribute to the insight of the role of the infectious agent in ethiopathogenesis of the Reiter's syndrome development, which could directly influence the choice of treatment of these patients.

METHODS

Eighteen patients with urogenital form of the Reiter's syndrome and 16 controls (6 with rheumatoid arthritis and 10 with pigmented villonodular synovitis) were included in the study. In all patients standard laboratory analyses of the blood, urine and stool were made; antibody titer to Chlamydia trachomatis and Ureaplasma urealyticum was determined in synovial fluid and serum; isolation of Chlamydia trachomatis and Ureaplasma urealyticum in urethral, cervical and conjunctival swabs, as well as in prostatic and synovial fluid, was also made. HLA typing was done, too. Chlamydia was isolated in the McCoy cell culture treated with cycloheximide, while Ureaplasma was identified according to its biochemical properties grown on cell-free liquid medium.

RESULTS

Chlamydia trachomatis was isolated from the synovial fluid of 4 patients with Reiter's syndrome (22.2%), while Ureaplasma urealyticum was isolated in 7 of them (38.9%). These microorganisms were not found in any synovial fluid of the control group patients.

CONCLUSION

Presence of these bacteria in the inflamed joint might be an important factor in etiopathogenesis of this disease, and it supports the hypothesis that arthritis in Reiter's syndrome is probably of the infectious origin.

A 4.1-kilodalton polypeptide in the cultural supernatant of Mycoplasma fermentans is one of the substances responsible for induction of interleukin-6 production by human gingival fibroblasts

The cultural supernatant of Mycoplasma fermentans induced interleukin-6 production by human gingival fibroblasts. The active entities were divided into hydrophilic and hydrophobic substances. In this study, we purified a 4.1-kilodalton polypeptide from the hydrophilic substances. It reacted with polyclonal antibodies to M. fermentans and activated human macrophages.

Substance P and mast cells: preliminary histologic analysis of the human temporomandibular joint

PURPOSE

Neuropeptide-containing nerves can serve as a mechanism for nervous system regulation of host defense responses. Because bacteria associated with reactive arthritis have been identified in the temporomandibular joint (TMJ), this study investigates whether the presence of substance P (SP) neuropeptide-containing nerves and mast cells can be identified in the TMJ.

MATERIAL AND METHODS

Posterior bilaminar tissue removed during TMJ surgery from 9 women was evaluated for the presence of neuropeptide-containing nerves by staining with a monoclonal antibody to SP. Staining of the TMJ tissue sections with 0.5% toluidine blue was performed to identify the presence of mast cells.

RESULTS

SP-containing nerves and mast cells were identified within the posterior bilaminar tissue associated with the vasculature.

CONCLUSIONS

The presence of neuropeptide nerves and mast cells within the TMJ has been shown. Mast cell degranulation products and SP release can contribute to TMJ inflammation.

Insights into the Role of Infection in the Spondyloarthropathies

Certain infections play an important role in the pathogenesis of the human leukocyte antigen (HLA)-B27-associated reactive arthritis. Whether infections play a role in other forms of spondyloarthropathies is not as clear. The role of HLA-B27 as an antigen-presenting molecule is important in the pathogenesis of these diseases. Recent evidence has been obtained indicating that this molecule may have other functions unrelated to antigen-presentation in the interaction of reactive arthritis-triggering microbes and host. This paper reviews the recent studies on the role of infection in the spondyloarthropathies.

Defective Fas ligand-mediated apoptosis predisposes to development of a chronic erosive arthritis subsequent to Mycoplasma pulmonis infection

OBJECTIVE

To determine whether defective T cell apoptosis is associated with the development of a chronic arthritis subsequent to mycoplasma infection, and to determine whether deletion of T cells can prevent the development of this arthritis.

METHODS

B6 wild-type (B6-+/+), B6-lpr/lpr, and B6-gld/gld mice were infected with Mycoplasma pulmonis. The severity of lymphocytic infiltration and joint damage was evaluated, and the degree of recovery of viable mycoplasma from the spleen and joints was determined. Antigen-presenting cells derived from Fas mutant lpr mice (lpr-APC) were transfected ex vivo with an adenovirus (Ad) vector to yield lpr-APC expressing high levels of Fas ligand (lpr-APC-AdFasL), which in turn were transferred intraperitoneally into M pulmonis-infected B6-gld/gld mice. The development of arthritis subsequent to M pulmonis infection and the induction of apoptosis of cells within the synovial tissue and lymph nodes of lpr-APC-AdFasL-treated B6-gld/gld mice were determined.

RESULTS

Infection of B6-lpr/lpr and B6-gld/gld mice with M pulmonis resulted in an acute-phase inflammation of the synovium that later developed into a chronic erosive arthritis. Similar infection of B6-+/+ mice resulted only in an acute joint inflammatory response that resolved. Chronic arthritis in B6-gld/gld mice and B6-lpr/lpr was not due to persistent infection, since there were no differences in the rates of clearance of M pulmonis from the joints of B6-gld/gld or B6-lpr/lpr mice compared with B6-+/+ mice. Treatment of infected B6-gld/gld mice with lpr-APC-AdFasL resulted in a significantly decreased incidence of chronic arthritis that was associated with a decrease in lymph node T cells, but not with apoptosis of synovial T cells or fibroblasts.

CONCLUSION

Defective Fas/FasL-mediated apoptosis of T cells is an important factor that rendered arthritis-resistant B6 mice susceptible to the development of a chronic erosive arthritis subsequent to mycoplasma infection. In vivo lpr-APC-AdFasL cell-gene therapy is a safe and effective method for inhibiting the development of this arthritis.

Frequency of chlamydial antibodies in patients with internal derangement of the temporomandibular joint

PURPOSE

This study investigates whether an increased frequency of serum antibodies to Chlamydia trachomatis is found in patients with internal derangement of the temporomandibular joint (TMJ).

PATIENTS AND METHODS

An indirect immunofluorescence antibody assay for the detection of serum immunoglobulin G antibodies for C trachomatis was used for most patients. Forty-one female patients were evaluated.

RESULTS

Three of 41 patients (7%) had serum antibody titers that were considered positive for active C trachomatis infection. Eleven patients (27%) were considered to have had a past infection based on the immunoglobulin G or immunoglobulin A titer results. Using the binomial test, we found that the probability of observing 14 positive results (34%) was significant (P < .0001).

CONCLUSIONS

An increase in the frequency of serum antibodies to C trachomatis was found in patients with internal derangement of the TMJ. Serologic testing for antibodies to bacteria associated with reactive arthritis might be useful in the evaluation of patients with internal derangement of the TMJ.