1
|
Carlsson AD, Wahlund K, Ghafouri B, Kindgren E, Frodlund M, Salé H, Klintström E, Johansson CS, Alstergren P. Parotid saliva and blood biomarkers in juvenile idiopathic arthritis in relation to temporomandibular joint magnetic resonance imaging findings. J Oral Rehabil 2024; 51:2082-2092. [PMID: 39007294 DOI: 10.1111/joor.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) often affects the temporomandibular joint (TMJ) caused by an abnormal immune system that includes overactive inflammatory processes. Salivary biomarkers may be a powerful tool that can help establishing diagnosis, prognosis and monitor disease progress. OBJECTIVE The objective was to investigate biomarkers in parotid saliva and blood plasma in relation to temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings in patients with JIA and healthy individuals. METHODS Forty-five children aged 6 to 16 years with JIA and 16 healthy age- and sex-matched controls were included. Unstimulated parotid saliva samples and venous blood were collected. Biochemical analyses were performed for the cytokine biomarkers. The participants underwent MR imaging of the TMJs, where changes in the inflammatory and the damage domains were assessed. RESULTS In the JIA patients, lower concentrations of IL-6R and gp130 were found in parotid saliva than in plasma. Higher concentrations of IL-6 were found in parotid saliva than in plasma. IL-6, IL-6R and gp130 in parotid saliva explained the presence of bone marrow oedema and effusion in the JIA patients. CONCLUSIONS This study suggests that the IL-6 family in parotid saliva is associated with TMJ bone marrow oedema and effusion in patients with JIA, suggesting that IL-6 has promising properties as a parotid saliva biomarker for TMJ inflammatory activity.
Collapse
Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Bijar Ghafouri
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skövde Hospital, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Salé
- Department of Neuroradiology, Center of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carin Starkhammar Johansson
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
| |
Collapse
|
2
|
Hysa E, Lercara A, Cere A, Gotelli E, Gerli V, Paolino S, Pizzorni C, Sulli A, Smith V, Cutolo M. Temporomandibular disorders in immune-mediated rheumatic diseases of the adult: A systematic review. Semin Arthritis Rheum 2023; 61:152215. [PMID: 37167773 DOI: 10.1016/j.semarthrit.2023.152215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/24/2022] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To systematically review the literature concerning temporomandibular disorders (TMDs) in immune-mediated rheumatic diseases (IMRDs) of the adult. The temporomandibular joint (TMJ) outcomes used in clinical studies, the prevalence of TMDs in IMRDs and the risk factors for their development were qualitatively synthetized. METHODS A literature search on PubMed Central, Embase and Cochrane Library databases was performed for studies including TMJ outcomes in IMRDs patients compared with healthy controls, other rheumatic diseases or in the assessed IMRDs patients after follow-up and treatment. Among the IMRDs of the adult, original articles investigating TMJ involvement in inflammatory polyarthritides and/or autoimmune connective tissue diseases were considered. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS Of the 3259 screened abstracts, 56 papers were included in the systematic review. Most of the papers (77%) investigated TMDs in rheumatoid arthritis (RA) with a prevalence of signs and symptoms varying from 8% to 70%. The risk factors for TMDs development in RA were female sex, younger age, anti-citrulline peptide autoantibodies (ACPA) positivity, higher disease activity, cervical spine involvement, cardiovascular and neuropsychiatric comorbidities. Ten papers (18%) evaluated TMDs in spondylarthritides (SpA) reporting a prevalence of symptoms and signs in 12%-80% of patients with higher TMDs prevalence in patients with radiographic spine involvement, skin psoriasis and HLADRB1×01 positivity. Among autoimmune connective tissue diseases (CTDs), systemic sclerosis (SSc) displayed the highest evidence of TMDs patient-reported outcomes (PROs) and clinical findings (20-93%), followed by systemic lupus erythematosus (SLE) in 18-85%, primary Sjogren's syndrome (24-54%) and idiopathic inflammatory myopathies (4-26%). In SSc and SLE, TMDs were more frequent in patients with higher disease activity and duration, correlating with the extent of skin fibrosis in SSc and with renal involvement in SLE. CONCLUSION TMDs in IMRDs display a significant relevance in the rheumatological clinical practice even if often misdiagnosed. This burden is epidemiologically important in terms of PROs and clinical findings which correlate with disease activity in RA, SpA, SSc and SLE. The early recognition and multidisciplinary management of TMDs is warranted and should be aimed at hindering the TMJ structural damage maximizing the quality of life of patients.
Collapse
Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Adriano Lercara
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Veronica Gerli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Department of Rheumatology, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, University of Genova, IRCCS San Martino Polyclinic Hospital Viale Benedetto XV, No 6, Genova 16132, Italy.
| |
Collapse
|
3
|
Magnetic resonance image texture analysis of the lateral pterygoid muscle in patients with rheumatoid arthritis: a preliminary report. Oral Radiol 2023; 39:242-247. [PMID: 35701653 DOI: 10.1007/s11282-022-00625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) is useful for assessing temporomandibular disorders (TMDs). However, few studies have attempted texture analysis of the lateral pterygoid muscle in patients with rheumatoid arthritis (RA). This study aims to investigate the usefulness of MRI texture analysis of the lateral pterygoid muscle of patients with RA of the temporomandibular joint (TMJ). METHODS We analyzed the data from 36 patients (18 non-RA patients and 18 RA patients) who complained of pain and underwent MRI between April 2008 and August 2021. From the MRI scans of these patients, 279 radiomics features were extracted using STIR image data of the ROIs on the lateral pterygoid muscle of patients with RA and analyzed using MaZda ver. 3.3. Seven gray-level co-occurrence matrix features (Sum entropy, Sum variance) were picked up using the Fisher coefficient, for comparison between the RA and non-RA groups. Data analysis was performed using the Mann-Whitney U test A P value of < 0.05 was considered as statistically significant. RESULTS All seven lateral pterygoid muscle radiomic features indicated significant differences between the non-RA and RA groups (P < 0.05). CONCLUSION MRI texture analysis shows potential for application in radiomics diagnosis of RA in TMJ.
Collapse
|
4
|
Ferrillo M, Giudice A, Migliario M, Renó F, Lippi L, Calafiore D, Marotta N, de Sire R, Fortunato L, Ammendolia A, Invernizzi M, de Sire A. Oral-Gut Microbiota, Periodontal Diseases, and Arthritis: Literature Overview on the Role of Probiotics. Int J Mol Sci 2023; 24:4626. [PMID: 36902056 PMCID: PMC10003001 DOI: 10.3390/ijms24054626] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023] Open
Abstract
Periodontal diseases are oral inflammatory diseases affecting the tissues supporting and surrounding the teeth and include gingivitis and periodontitis. Oral pathogens may lead to microbial products spreading into the systemic circulation and reaching distant organs, while periodontal diseases have been related to low-grade systemic inflammation. Gut and oral microbiota alterations might play a role in the pathogenesis of several autoimmune and inflammatory diseases including arthritis, considering the role of the gut-joint axis in the regulation of molecular pathways involved in the pathogenesis of these conditions. In this scenario, it is hypothesized that probiotics might contribute to the oral and intestinal micro-ecological balance and could reduce low-grade inflammation typical of periodontal diseases and arthritis. This literature overview aims to summarize state-of-the-art ideas about linkages among oral-gut microbiota, periodontal diseases, and arthritis, while investigating the role of probiotics as a potential therapeutic intervention for the management of both oral diseases and musculoskeletal disorders.
Collapse
Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Mario Migliario
- Dentistry Unit, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Filippo Renó
- Innovative Research Laboratory for Wound Healing, Health Sciences Department, University of Eastern Piedmont, 28100 Novara, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Dario Calafiore
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Roberto de Sire
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy
| | - Leonzio Fortunato
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| |
Collapse
|
5
|
A Retrospective Clinical Trial Regarding Oral Rehabilitation Diagnosis Strategies Based on Stomatognathic System Pathology. Biomedicines 2023; 11:biomedicines11020622. [PMID: 36831158 PMCID: PMC9952906 DOI: 10.3390/biomedicines11020622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Orofacial pain is a common occurrence in daily dental practice; it is frequently attributed to temporomandibular dysfunction, one of its major causes, followed by pathology of the salivary glands, without avoiding interference at the level of the pain pathways caused by complications of periodontal pathology. The main objective of this study is to identify an important cause of pain in the oral-maxillofacial territory by quantifying the changes at the salivary glandular level using stereological methods. The secondary objective of the present research is to identify the implications of periodontal changes as a consequence of salivary quantitative and qualitative changes, quantified using periodontal indices, on the balance of the temporomandibular joint, dysfunction of it being an important cause of facial pain and having a profound impact on the complex oral rehabilitation algorithm of each clinical case, a condition evaluated with the analysis of the results of the Souleroy questionnaire. MATERIAL AND METHODS In a retrospective study, we evaluated the clinical results obtained after applying complex rehabilitation treatment to 35 subjects, 20 women and 15 men with salivary and TMJ dysfunctions, selected between 2020 and 2021 from the Clinic of Maxillofacial Surgery, Iasi. RESULTS AND DISCUSSION The most common symptoms of temporomandibular disorders (TMDs) that were identified through the Souleroy questionnaire were pain and different types of damage to the masticatory muscles. The most significant changes in elders are reported in the case of serous cells, which reduced their percentage volume from 46.7% to 37.4%. CONCLUSION As regards stereological analysis in conjunction with histological images, there were significant changes in diameters, perimeters, and longitudinal axes in the adult patients as opposed to the elderly patients, which were also influenced by the type of pathology at this level. The scores recorded on the diagnostic Souleroy scale indicated a large number of patients with low efficiency and maximum stress levels: 20.0% in level 1, 25.7% in level 2, and 25.7% in level 3.
Collapse
|
6
|
Jalal RA, Ahmed KM, Saeed SM, Qaradaghi TA. Correlation of clinical findings of temporomandibular joint with serological results in rheumatoid arthritis patients. Clin Exp Dent Res 2022; 8:1270-1276. [PMID: 35767468 PMCID: PMC9562840 DOI: 10.1002/cre2.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to determine the frequency of temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis (RA) and to find out the correlation of serological tests with clinical symptoms of TMJs in RA patients. PATIENTS AND METHODS This cross-sectional study was performed on 40 patients with RA classified into two groups according to their duration of the disease. Clinical examination as well as laboratory tests were done for participants. RESULTS The frequency of TMJ involvement clinically was 15% in Group A and 40% in Group B. The most frequently observed clinical symptom was facial pain (25%), and the slightest symptom was clicking (2.5%) during mouth opening. There was a positive correlation between ESR, RF, CRP and anti-CCP and clinical sign and symptoms of TMJs in RA patients. An elevated ESR, RF CRP and anti-CCP may indicate the presence of TMJ complains in RA patients. The chronicity of RA affects the frequency of TMJ involvement clinically, patients with longer disease duration have more clinical symptoms of TMJs. An elevated level of ESR, RF, CRP and anti-CCP predict clinical symptoms of TMJs.
Collapse
Affiliation(s)
- Ranj A. Jalal
- Department of Oral Diagnosis, College of DentistryUniversity of SulaimaniSulaimaniyahIraq
| | - Khadija M. Ahmed
- Department of Oral Diagnosis, College of DentistryUniversity of SulaimaniSulaimaniyahIraq
| | - Shahla M. Saeed
- Department of SurgeryUniversity of SulaimaniSulaimaniyahIraq
| | - Taha A. Qaradaghi
- Bone Mineral Density and Osteoporosis Center, Ministry of HealthSulaimaniyah Internal Medicine Teaching HospitalSulaimaniyahIraq
| |
Collapse
|
7
|
HELMS JBDS, BARBOSA CA, ABRAHÃO AC, CABRAL MG, BICA BERG, TORRES SR. Are salivary flow rates associated with histopathologic aspects in patients with rheumatoid arthritis? Braz Oral Res 2022; 36:e0120. [DOI: 10.1590/1807-3107bor-2022.vol36.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
|
8
|
Zanin MC, Garcia DM, Rocha EM, de Felício CM. Orofacial Motor Functions and Temporomandibular Disorders in Patients With Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2020; 72:1057-1065. [PMID: 31207153 DOI: 10.1002/acr.24001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Sjögren's syndrome (SS) induces difficulty in chewing and swallowing due to low salivary flow. However, these symptoms may be associated with other factors, such as orofacial myofunctional disorders and temporomandibular disorder (TMD), which have not been comprehensively assessed in this population. The aims of this study were to investigate orofacial muscles and functions as well as the presence of TMD in patients with SS compared with a group without SS and to analyze whether the patients' experience of limitations in orofacial functioning is associated with the orofacial functional status and muscle pain related to TMD. METHODS Women with SS based on the 2002 American-European Consensus Group criteria and volunteers paired by age and sex were compared. The examinations included the orofacial myofunctional evaluation with scores (OMES) protocol, tongue and lip strength measures, and electromyography of the masticatory muscles. TMD investigations included clinical examination, self-report of symptoms, and assessment according to the Jaw Functional Limitation Scale. RESULTS Patients with SS present with impaired muscle and orofacial functions based on lower scores of all categories of OMES (P < 0.0001), tongue strength (P = 0.0003-0.0004), and masticatory muscle activity (P = 0.0002-0.007), as well as worse TMD signs and symptoms (P < 0.05) and jaw functional limitation (P < 0.0001-0.0003). CONCLUSION Patients' experiences with limitation in mastication and swallowing were associated with orofacial myofunctional status and muscle pain related to TMD. Those disorders should be monitored along with disease control and must be addressed in the clinical evaluation to prevent nutritional and metabolic comorbidities in patients with SS.
Collapse
|
9
|
Temporomandibular joint function, periodontal health, and oral microbiome in early rheumatoid arthritis and at-risk individuals: a prospective cohort study protocol. BDJ Open 2020; 6:7. [PMID: 32467775 PMCID: PMC7237646 DOI: 10.1038/s41405-020-0034-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/09/2022] Open
Abstract
Objectives/aims Rheumatoid arthritis (RA) is an autoimmune disease affecting the joints, including the temporomandibular joint (TMJ). Early diagnosis and treatment can alleviate symptoms and prevent progression. Predictors for disease outcome in individuals at risk for RA are therefore valuable. While limited information is available on the prevalence of TMJ involvement in early RA, previous studies suggest that RA, periodontitis and the oral microbiome are interrelated. Predictive factors for RA development may thus be present in the oral cavity. Our two aims are: (1) to assess the prevalence of TMJ involvement in early RA, and (2) to investigate the predictive value of oral factors in RA development. Materials and methods We will include 150 individuals in this multi-center, prospective cohort study: 50 patients with early RA, 50 at-risk individuals, and 50 healthy controls. At baseline, the TMJ, periodontal health, and the oral microbiome will be examined. The general health will be followed over time, on four occasions up to 3 years. Discussion Our results will provide insight into the prevalence and clinical characterization of TMJ involvement in early RA. For at-risk individuals, oral factors can be studied as possible predictors for the development of RA.
Collapse
|
10
|
Dimitrijevic Carlsson A, Ghafouri B, Starkhammar Johansson C, Alstergren P. Unstimulated Parotid Saliva Sampling in Juvenile Idiopathic Arthritis and Healthy Controls: A Proof-of-Concept Study on Biomarkers. Diagnostics (Basel) 2020; 10:diagnostics10040251. [PMID: 32344523 PMCID: PMC7236018 DOI: 10.3390/diagnostics10040251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022] Open
Abstract
The aims of this proof-of-concept study were to develop a collecting method for unstimulated parotid saliva in juvenile idiopathic arthritis (JIA) patients and healthy children and to investigate if inflammatory biomarkers could be detected in these samples. Forty-five children with JIA (median age of 12 years and 25th–75th percentile of 10–15 years; 33 girls and 12 boys) and 16 healthy children as controls (median age of 13 years and 25–75th percentile of 10–13 years; 11 girls and 5 boys) were enrolled in this study. Unstimulated parotid saliva was collected with a modified Carlson–Crittenden collector. The salivary flow rate and salivary concentrations of total protein and inflammatory mediators were assessed. The Meso Scale Discovery electrochemiluminescence immunoassay was used for analyzing protein concentrations and the inflammatory biomarkers. Sufficient parotid saliva volumes to be analyzed could be collected with the collection device. JIA patients had a lower sampling saliva volume (p = 0.008) and saliva flow rate (p = 0.039) than controls. The total protein concentrations and inflammatory biomarkers were measured in the last six healthy subjects. The median protein concentration was 1312 µg/mL (25th percentile: 844 µg/mL and 75th percentile: 2062 µg/mL; n = 6) and quantifiable concentrations of 39 inflammatory proteins could be assessed in these samples. In conclusion, this study indicates that the saliva sampling method, as used in the present study, is able to collect sufficient sample volumes in children, and that it is possible to analyze various inflammatory biomarkers in the collected saliva.
Collapse
Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Center for Oral Rehabilitation, Department of Biomedical and Clinical Science, Linköping University, 581 83 Linköping, Sweden;
- Orofacial Pain Unit, Faculty of Odontology, Malmö University, Carl Gustafs väg 34, 214 21 Malmö, Sweden;
- Correspondence:
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, 581 83 Linköping, Sweden;
| | - Carin Starkhammar Johansson
- Center for Oral Rehabilitation, Department of Biomedical and Clinical Science, Linköping University, 581 83 Linköping, Sweden;
| | - Per Alstergren
- Orofacial Pain Unit, Faculty of Odontology, Malmö University, Carl Gustafs väg 34, 214 21 Malmö, Sweden;
- Orofacial Pain and Jaw Function, Institute of Dental Medicine, Karolinska Institute, Alfred Nobels allé 8, 141 52 Huddinge, Sweden
- Specialized Pain Rehabilitation, Skåne University Hospital, Lasarettsgatan 13, 222 41 Lund, Sweden
| |
Collapse
|
11
|
Hutami IR, Tanaka E, Izawa T. Crosstalk between Fas and S1P 1 signaling via NF-kB in osteoclasts controls bone destruction in the TMJ due to rheumatoid arthritis. JAPANESE DENTAL SCIENCE REVIEW 2019; 55:12-19. [PMID: 30733840 PMCID: PMC6354287 DOI: 10.1016/j.jdsr.2018.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/27/2018] [Accepted: 09/18/2018] [Indexed: 12/20/2022] Open
Abstract
Rheumatoid arthritis (RA) mainly affects various joints of the body, including the temporomandibular joint (TMJ), and it involves an infiltration of autoantibodies and inflammatory leukocytes into articular tissues and the synovium. Initially, the synovial lining tissue becomes engaged with several kinds of infiltrating cells, including osteoclasts, macrophages, lymphocytes, and plasma cells. Eventually, bone degradation occurs. In order to elucidate the best therapy for RA, a comprehensive study of RA pathogenesis needs to be completed. In this article, we discuss a Fas-deficient condition which develops into RA, with an emphasis on the role of sphingosine 1-phosphate (S1P)/S1P receptor 1 signaling which induces the migration of osteoclast precursor cells. We describe that Fas/S1P1 signaling via NF-κB activation in osteoclasts is a key factor in TMJ-RA severity and we discuss a strategy for blocking nuclear translocation of the p50 NF-κB subunit as a potential therapy for attenuating osteoclastogenesis.
Collapse
Affiliation(s)
| | | | - Takashi Izawa
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University, Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima 7708504, Japan
| |
Collapse
|
12
|
Youssef Mohamed MM, Dahaba MM, Farid MM, Ali Elsayed AM. Radiographic changes in TMJ in relation to serology and disease activity in RA patients. Dentomaxillofac Radiol 2019; 49:20190186. [PMID: 31530023 DOI: 10.1259/dmfr.20190186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES This study was undertaken as an attempt to assess radiographic temporomandibular joint (TMJ) changes in relation to rheumatoid factor (RF), anticitrullinated protein (ACCP) antibodies and disease activity score 28 (DAS28) in rheumatoid arthritis (RA) patients to find the best predictor of rheumatoid affection of the TMJ with the ultimate goal of maintaining TMJ function and preventing joint damage. METHODS 20 Rheumatoid Arthritis patients as well as 20 volunteers were included in this study. RA group were assessed for RF, ACCP, DAS28. Both groups were assessed by CBCT for TMJ dimensions and radiographic osteoarthritic changes. All data were statistically analyzed. RESULTS Rheumatoid Arthritis group showed significantly less condylar height and more radiographic osteoarthritic changes than the control group. RF showed no significant correlation with either TMJ measurements or TMJ radiographic osteoarthritic changes. ACCP showed significant inverse correlation with condylar height and anteroposterior (AP) dimensions, but non-significant relation with mediolateral dimension and radiographic osteoarthritic changes. DAS28 showed significant inverse correlation with condylar AP and mediolateral dimensions. It also showed significant correlation with flattening of the TMJ condylar head and flattening of the articular fossa. Patients with high and moderate disease activity showed significantly smaller AP TMJ dimension than patients with low disease activity. Disease activity showed statistically significant direct correlation with all osteoarthritic changes except for erosions of the glenoid fossa and condyle. CONCLUSION Disease Activity Score28 score and disease activity are strong indicators of TMJ affection in RA patients when compared to RF and ACCP. ACCP is a better indicator of changes in condylar measurements than TMJ osteoarthritic changes. While RF is the least efficient indicator of TMJ involvement in RA patients.
Collapse
Affiliation(s)
| | - Mushira M Dahaba
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Mary Medhat Farid
- Department of Oral Medicine, Periodontology, Diagnosis and Oral Radiology, Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
| | | |
Collapse
|
13
|
de Souza S, Bansal RK, Galloway J. Rheumatoid arthritis - an update for general dental practitioners. Br Dent J 2018; 221:667-673. [PMID: 27857093 DOI: 10.1038/sj.bdj.2016.866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disorder which significantly impacts patients' lives and can lead to permanent disability. Inflammation in RA not only affects joints; but can affect organs including the heart and lungs. Early diagnosis, initiation of intensive drug therapy, and a multidisciplinary care approach have vastly improved the long-term prognosis for those living with the condition. However, RA patients often present with co-morbidities which add to the complexity of clinical management. Orofacial conditions associated with RA which dental professionals need to be aware of include periodontal disease, temporomandibular dysfunction and salivary gland dysfunction. In this article, we provide information on RA, oral health in RA and guidance on how best to manage patients with RA in general dental practice.
Collapse
Affiliation(s)
- S de Souza
- Academic Rheumatology, King's College London, London
| | - R K Bansal
- Springfield Dental Practice, Chelmsford and MSc Student, Dental Institute, King's College London, London
| | - J Galloway
- Academic Rheumatology, King's College London, London and Honorary Consultant Rheumatologist, Rheumatology, King's College Hospital NHS Foundation Trust, London
| |
Collapse
|
14
|
EL-Melegy DN, El-Khouly RM, Mwafi MEED, Zyton HAEH. Magnetic resonance imaging versus musculoskeletal ultrasound in the evaluation of temporomandibular joint in rheumatoid arthritis patients. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
15
|
|
16
|
Yıldızer Keriş E, Yaman SD, Demirağ MD, Haznedaroğlu Ş. Temporomandibular joint findings in patients with rheumatoid arthritis, ankylosing spondylitis, and primary Sjögren's syndrome. ACTA ACUST UNITED AC 2016; 8. [PMID: 27989011 DOI: 10.1111/jicd.12255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/22/2016] [Indexed: 01/22/2023]
Abstract
AIM The aim of the present study was to investigate the prevalence of temporomandibular joint (TMJ) symptoms in rheumatoid arthritis (RA), primary Sjögren's syndrome (pSS), and ankylosing spondylitis (AS) patients. METHODS The present study consisted of 79 individuals with various rheumatic disease (study group: 39 with RA, 17 with AS, 23 with pSS) and 79 age- and sex-matched healthy controls (control group). Subjective symptoms of the TMJ were recorded by means of a questionnaire. And stomatognathic examination was then performed. RESULTS The prevalence of subjective symptoms in patients with rheumatic disease (73.4%) were significantly higher than that of the controls (22.8%; P<.05). The most common objective symptoms were pain during lateral TMJ palpation (29.1% of patients overall, 8.9% of controls) and mandibular movements (19% of patients overall, 2.5% of controls), and muscle pain during palpation (38% of patients overall, 3.8% of controls). They were significantly higher in all of the rheumatic patients than the controls (P<.05). There was not a statistically-significant difference in the values for mandibular movements between the study and control groups (P>.05, Mann-Whitney U test). CONCLUSIONS TMJ symptoms were observed to be higher in the patients with RA, AS and pSS than the control group. Dentists and rheumatologists should be aware of TMJ symptoms in patients with rheumatic diseases.
Collapse
Affiliation(s)
| | | | | | - Şeminur Haznedaroğlu
- Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
17
|
Lins E Silva M, Carvalho CN, Carvalho ADAT, Leão JC, Duarte ALP, Gueiros LA. Effect of Xerostomia on the Functional Capacity of Subjects with Rheumatoid Arthritis. J Rheumatol 2016; 43:1795-1800. [PMID: 27585681 DOI: 10.3899/jrheum.151211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the intensity of xerostomia and hyposalivation in subjects with rheumatoid arthritis (RA) as well as the effects of these conditions on functional incapacity and disease activity. METHODS The study sample comprised 236 individuals of both sexes who had RA. All the individuals were submitted to clinical evaluation and unstimulated sialometry. Functional capacity was determined by using the Health Assessment Questionnaire (HAQ), xerostomia was assessed using the Xerostomia Inventory, and disease activity was evaluated with the 28-joint Disease Activity Score (DAS28). The effect of Sjögren syndrome (SS) was analyzed, and the sample was divided into 2 groups: RA (191 subjects) and RA/SS (45 subjects). RESULTS The Xerostomia Inventory showed positive and significant correlation with fatigue (r = 0.243; p < 0.0001), number of painful joints (r = 0.218; p = 0.001), HAQ (r = 0.279; p < 0.0001), and DAS28 (r = 0.156; p < 0.0001). On regression analysis, both xerostomia (OR 3.89, 95% CI 1.84-8.23, p < 0.001) and DAS28 (for severe disease activity: OR 13.26, 95% CI 3.15-55.79, p < 0.001) showed influence on functional incapacity. Forty-five individuals (19.1%) presented with secondary SS, and having this diagnosis was not associated with disease activity or functional capacity. CONCLUSION Xerostomia demonstrated an adverse effect on quality of life of subjects with RA, being associated with a reduction in functional capacity. In this clinical setting, xerostomia can be monitored as a marker of worse clinical evolution.
Collapse
Affiliation(s)
- Marília Lins E Silva
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
| | - Camila Nunes Carvalho
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
| | - Alessandra de Albuquerque Tavares Carvalho
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
| | - Jair Carneiro Leão
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
| | - Angela Luzia Pinto Duarte
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco
| | - Luiz Alcino Gueiros
- From the Oral Medicine Unit, Department of Clinical and Preventive Dentistry, and the Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco, Recife, Brazil.M. Lins e Silva, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; C.N. Carvalho, DDS, MSc, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.A. Carvalho, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; J.C. Leão, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco; A.L. Duarte, DDS, MSc, PhD, Rheumatology Unit, Clinics Hospital, Federal University of Pernambuco; L.A. Gueiros, DDS, MSc, PhD, Oral Medicine Unit, Department of Clinical and Preventive Dentistry, Federal University of Pernambuco.
| |
Collapse
|
18
|
TORRES SR, PEDRAZAS CHS, CORREIA MPV, AZEVEDO MNLD, ZAMPROGNO T, SILVA JUNIOR A, GONÇALVES LS, PAPI JADS. Drugs or disease: evaluating salivary function in RA patients. Braz Oral Res 2016; 30:e106. [DOI: 10.1590/1807-3107bor-2016.vol30.0106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/19/2016] [Indexed: 11/21/2022] Open
|
19
|
Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:328560. [PMID: 25243130 PMCID: PMC4160621 DOI: 10.1155/2014/328560] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/02/2014] [Accepted: 07/13/2014] [Indexed: 11/17/2022]
Abstract
This study included 30 patients with diagnosed rheumatoid arthritis (RA) and 30 test subjects without RA (control group). The objective of the study was to examine both groups for the presence of temporomandibular disorders (TMD) and morphological changes of the temporomandibular joint (TMJ). All individuals were examined using a systematic detailed clinical TMD examination as well as magnetic resonance imaging (MRI). The clinical TMD examination yielded significant differences between the RA patients and the control group concerning crepitus of the TMJ, and palpation tenderness of the masticatory muscles as well as the unassisted mandibular opening. The evaluation of the MRI images for the RA group showed significantly more frequent deformations of the condyle, osteophyte formations and erosions in the condylar compacta, and degenerative changes in the spongiosa. Increased intra-articular accumulation of synovial liquid and signs of inflammatory changes of the spongiosa were only found in the RA group. Statistical analysis showed a significant correlation between crepitus and specific osteoarthrotic changes (MRI), respectively, and between crepitus and a complete anterior disk displacement without reduction (MRI). The duration of the RA disease correlated neither with the anamnestic and clinical dysfunction index by Helkimo nor with RA-specific MRI findings.
Collapse
|
20
|
Bono AE, Learreta JA, Rodriguez G, Marcos JC. Stomatognathic system involvement in rheumatoid arthritis patients. Cranio 2014; 32:31-7. [PMID: 24660644 DOI: 10.1179/0886963413z.0000000003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
AIMS Temporomandibular joint (TMJ) and stomatognathic system involvement are usually observed during the course of rheumatoid arthritis. METHODOLOGY This article presents the findings during examination of 190 TMJs from rheumatoid arthritis (RA) patients, and 44 TMJs from controls without RA, including a description of signs and symptoms related to the stomatognathic system, radiological findings in hands-, and TMJ, erythrocyte sedimentation rate (ESR) values, and scores obtained in the Disease Activity Score (Das 28) and the Health Assessment Questionnaire (HAQ). RESULTS The sample included 57.89% TMJs associated with spontaneous pain, 87.89% with signs of destruction in radiological images, and 58.94% with 20 teeth or less. Restricted mouth opening was detected in 42.1% of RA patients, from which 71% had blocked opening; headache was present in 58%, and pain in the masticatory muscles was found in 57%. TMJ erosions had a significant association with Larsen scores (r=0.62), but not with the Das 28, HAQ, and ESR values. CONCLUSIONS The early evaluation of this joint and the collaborative work of odontologists and rheumatologists are both necessary for a better management of TMJ pathologies.
Collapse
|
21
|
Bilateral TMJ Involvement in Rheumatoid Arthritis. Case Rep Dent 2014; 2014:262430. [PMID: 24804125 PMCID: PMC3996894 DOI: 10.1155/2014/262430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/06/2014] [Indexed: 12/02/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory, slowly progressive disease that results in cartilage and bone destruction. Temporomandibular joint (TMJ) involvement is not uncommon in RA, and it is present in about more than 50% of patients; however, TMJ is usually among the last joints to be involved and is associated with many varied clinical signs and symptoms. Hence, RA of TMJ presents to the dentist with great diagnostic challenges. This report presents a case of RA with bilateral TMJ involvement with its classical radiographic findings and review literature.
Collapse
|
22
|
Zalewska A, Knaś M, Waszkiewicz N, Waszkiel D, Sierakowski S, Zwierz K. Rheumatoid arthritis patients with xerostomia have reduced production of key salivary constituents. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 115:483-90. [DOI: 10.1016/j.oooo.2012.10.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 10/09/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
|
23
|
|
24
|
Hiz O, Ediz L, Ozkan Y, Bora A. Clinical and magnetic resonance imaging findings of the temporomandibular joint in patients with rheumatoid arthritis. J Clin Med Res 2012; 4:323-31. [PMID: 23024735 PMCID: PMC3449430 DOI: 10.4021/jocmr1084w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 01/03/2023] Open
Abstract
Background The aim of this study is to evaluate temporomandibular joint (TMJ) involvement in patients with rheumatoid arthritis by magnetic resonance imaging (MRI), jaw clenching force, mouth opening, and Fonseca’s questionnaire, and to establish the relationship between these findings and clinical, radiologic, and laboratory activity parameters that are unique to rheumatoid arthritis. Methods Included in the study were 30 RA patients and 30 healthy volunteers. Jaw clenching force of the entire cases was measured with Istanbul Bite Force Recorder (kg) and the mouth opening was measured with a ruler (cm). Additionally, hand grip forces of patients with rheumatoid arthritis were measured with hand dynamometer (kg). Hand and feet graphs and TMJ MRIs of patients were obtained. MRI findings were classified as normal, mild, medium, and severe. DAS28 and sharp scores of patients were estimated. Sedimentation rate (ESR), C-Reactive protein (CRP) and rheumatoid factor (RF) were checked in the patient group and Fonseca’s questionnaires were filled in. Results A significant difference was not observed between age, gender, and level of education of the groups. Jaw clenching force and mouth opening were established as significantly low in RA group compared to the control group (P < 0.001). A significant correlation was found between jaw clenching force, hand grip force, mouth opening, questionnaire, and MRI findings with the disease duration sharp score, DAS28, and hand grip force of the RA group (P < 0.05). However, a significant correlation was not established with ESR, CRP, and RF (P < 0.001). Conclusions Jaw clenching force, mouth opening, and Fonseca’s questionnaire can be used as parameters pointing to TMJ involvement in patients with RA. Yet, further studies in which TMJ involvement is followed up since the onset of the disease are of necessity.
Collapse
Affiliation(s)
- Ozcan Hiz
- Yuzuncu Yil University Medical Faculty, Physical Medicine Rehabilitation and Rheumatology Department, Van, Turkey
| | | | | | | |
Collapse
|
25
|
Management of the temporomandibular joint in rheumatoid disorders. Br J Oral Maxillofac Surg 2012; 51:191-8. [PMID: 22658606 DOI: 10.1016/j.bjoms.2012.04.271] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/15/2012] [Indexed: 11/23/2022]
Abstract
This article summarises the rheumatoid diseases that particularly affect the temporomandibular joint (TMJ): psoriatic arthropathy, ankylosing spondylitis, and rheumatoid arthritis. Management is by a joint approach between rheumatologists and maxillofacial surgeons with a specific interest in diseases of the TMJ who give early surgical advice. Steroid injections, whilst useful in the short term, are not useful for long term or repeated treatment, and may lead to collapse of the joint and development of a deformed anterior open bite. These disorders should be managed primarily using standard conservative regimens, and failure to respond should lead to diagnostic or therapeutic arthroscopy and appropriate surgical treatment. When ankylosis develops or the joint collapses, a replacement joint should be considered and patients should be referred to an appropriately trained surgeon.
Collapse
|
26
|
Aliko A, Ciancaglini R, Alushi A, Tafaj A, Ruci D. Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. Int J Oral Maxillofac Surg 2011; 40:704-9. [PMID: 21459556 DOI: 10.1016/j.ijom.2011.02.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 01/19/2011] [Accepted: 02/22/2011] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to estimate the prevalence of temporomandibular joint (TMJ) symptoms and clinical findings in Albanian patients with rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. The authors examined 124 consecutive hospitalized patients (88 with rheumatoid arthritis, 22 with systemic lupus erythematosus and 14 with systemic sclerosis) and 124 age- and gender-matched healthy controls using a questionnaire and an oro-facial clinical examination for assessing the presence of TMJ sounds, pain in the TMJ area, tenderness of masticatory muscles and limited mouth opening. Significantly more patients (67%) reported TMJ symptoms than controls (19%). A significantly higher proportion of patients (65%) exhibited clinical signs of temporomandibular dysfunction compared with controls (26%). The most frequent findings in rheumatoid arthritis were temporomandibular sounds and pain. Pain was found in a significantly higher proportion in patients with systemic lupus erythematosus compared with controls. Difficulty and limitation in mouth opening were observed in the majority of systemic sclerosis patients, and in only a minority of rheumatoid arthritis patients. This study supports the notion that TMJ examination should be encouraged in the rheumatology setting and clinicians should be able to provide pain management and patient support.
Collapse
Affiliation(s)
- A Aliko
- Stomatology Department, Faculty of Medicine, University of Tirana, Albania.
| | | | | | | | | |
Collapse
|
27
|
Bracco P, Debernardi C, Piancino MG, Cirigliano MF, Salvetti G, Bazzichi L, De Feo F, Bosco M. Evaluation of the stomatognathic system in patients with rheumatoid arthritis according to the research diagnostic criteria for temporomandibular disorders. Cranio 2010; 28:181-6. [PMID: 20806736 DOI: 10.1179/crn.2010.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The aim of this study was to investigate the clinical features of stomatognathic dysfunction in patients with rheumatoid arthritis (RA). The study sample consisted of 40 patients with RA (34 female, 6 male), mean age 44 years, recruited at the Rheumatology Division of the Department of Internal Medicine, University of Pisa, Italy. The inclusion criteria were diagnosis of RA according to the criteria of the American Rheumatism Association (ARA). In the study, 82.5% (n=33) of patients affected by RA satisfied at least the criteria of one diagnosis of temporomandibular disorders (TMD), according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). The results are in agreement with the literature and the prevalence of such involvement ranges between 53% and 94% of patients. Several studies reported an involvement of the stomatognathic system in RA. In fact, RA can affect the temporomandibular joint as much as any other synovial joint. A more thorough analysis is required for a multidisciplinary approach to gnathological patients, including assessment by a rheumatologist. This issue and its epidemiologic relevance need further scientific research. Dentistry has a fundamental role in this process since patients who present with a systemic disease such as RA can be recognized and intercepted and referred to medical specialists, i.e., rheumatologists, to provide a diagnosis and therapy.
Collapse
Affiliation(s)
- Pietro Bracco
- Dept. of Orthodontics and Gnathology, Dental School, University of Turin, Via Nizza 230, 10126 Torino, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Aliko A, Ciancaglini R, Alushi A, Tafaj A. Sicca symptoms, and lacrimal and salivary flow in Albanian patients with rheumatoid arthritis. J Oral Pathol Med 2010; 39:651-6. [DOI: 10.1111/j.1600-0714.2010.00899.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Trombone AP, Claudino M, Colavite P, de Assis GF, Avila-Campos MJ, Silva JS, Campanelli AP, Ibañez OM, De Franco M, Garlet GP. Periodontitis and arthritis interaction in mice involves a shared hyper-inflammatory genotype and functional immunological interferences. Genes Immun 2010; 11:479-89. [PMID: 20428191 DOI: 10.1038/gene.2010.13] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Periodontitis (PD) and rheumatoid arthritis (RA) have been found to be clinically associated and to share the chronic nature of the inflammatory reaction associated with bone resorption activity. However, the mechanisms underlying such association are unknown. Therefore, we examined the basis of Actinobacillus actinomycetemcomitans- and Porphyromonas gingivalis-induced PD and pristane-induced arthritis (PIA) interaction in mice. Higher severity PD in the genetically inflammation prone acute inflammatory reactivity maximum (AIRmax) mice strain was associated with higher levels of TNF-alpha, IL-1beta, IL-17, matrix metalloproteinase (MMP)-13, and RANKL, whereas PD/PIA co-induction resulted in even higher levels of IL-1beta, IFN-gamma, IL-17, RANKL, and MMP-13 levels. Conversely, PD/PIA co-induction in AIRmin strain did not alter the course of both pathologies. PIA/PD co-induction resulted in altered expression of T-cell subsets transcription factors expression, with T-bet and RORgamma levels being upregulated, whereas GATA-3 levels were unaltered. Interestingly, PIA induction resulted in alveolar bone loss, such response being highly dependent on the presence of commensal oral bacteria. No differences were found in PIA severity parameters by PD co-induction. Our results show that the interaction between experimental PD and arthritis in mice involves a shared hyper-inflammatory genotype and functional interferences in innate and adaptive immune responses.
Collapse
Affiliation(s)
- A P Trombone
- Department of Biochemistry and Immunology, School of Medicine of Ribeirão Preto--FMRP/USP, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hasan EA, Jessop DS, Power LL, Monk PT, Kirwan JR. Use of the dexamethasone-corticotrophin releasing hormone test to assess hypothalamic-pituitary-adrenal axis function in rheumatoid arthritis. Int J Endocrinol 2009; 2009:391284. [PMID: 19946428 PMCID: PMC2778455 DOI: 10.1155/2009/391284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 06/06/2009] [Accepted: 07/21/2009] [Indexed: 11/18/2022] Open
Abstract
Objectives. Hypothalamic-Pituitary-Adrenal axis function may be abnormal in rheumatoid arthritis (RA). A pilot study in 7 patients suggested impaired glucocorticoid feedback in some patients after the dexamethasone-corticotrophin releasing hormone (CRH) test. This study aimed to investigate the dexamethasone-corticotrophin releasing factor test in a larger group of patients and relate the results to characteristics of the disease. Methods. Outpatients with active RA (>/=3 swollen and tender joints and C-reactive protein > 10 mg/L) took dexamethasone (1.5 mg) at 23:00 hour in the evening. Next day, baseline saliva and plasma samples were collected, CRH was infused at 11:00 hour, and 4 serial blood and saliva samples were collected. Plasma samples were stored at -80 degrees C and a radioimmunoassay performed for saliva and plasma cortisol. Results. All 20 participants showed normal dexamethasone suppression and mounted no response to the CRH challenge. In samples with measurable cortisol, there was a strong correlation between saliva and plasma values (r = 0.876, n = 26, P < .01). Conclusion. No abnormalities were found in the Dexamethasone-CRH test in RA patients in contrast to a previous pilot study. Salivary cortisol measurement may offer an alternative noninvasive technique to plasma cortisol in RA patients in future studies.
Collapse
Affiliation(s)
- Eman A. Hasan
- The Academic Rheumatology Unit, University of Bristol, UK
- *Eman A. Hasan:
| | - David S. Jessop
- Welcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, UK
| | | | - Paul T. Monk
- The Academic Rheumatology Unit, University of Bristol, UK
| | - John R. Kirwan
- The Academic Rheumatology Unit, University of Bristol, UK
| |
Collapse
|
31
|
Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations. ACTA ACUST UNITED AC 2007; 103 Suppl:S57.e1-15. [PMID: 17379156 DOI: 10.1016/j.tripleo.2006.11.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 11/08/2006] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia. STUDY DESIGN Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005. RESULTS Several systemic diseases were identified. From studies published 2002 to 2005, 15 were identified as high-quality studies and were used to support management recommendations: pilocarpine and cevimeline are recommended for treating hyposalivation and xerostomia in primary and secondary Sjögren's syndrome (SS). IFN-alpha lozenges may enhance saliva flow in primary SS patients. Anti-TNF-alpha agents, such as infliximab or etanercept, are not recommended to treat hyposalivation in SS. Dehydroepiandrosterone is not recommended to relieve hyposalivation or xerostomia in primary SS. There was not enough evidence to support any recommendations for the use of local stimulants, lubricants, and protectants for hyposalivation/xerostomia. However, professional judgment and patient preferences may support the use of a specific product for an individual patient. CONCLUSIONS These evidence-based management recommendations should guide the clinician's management decisions for patients with salivary dysfunction related to systemic disease. Future treatment strategies may include new formulations of existing drugs, e.g., local application of pilocarpine. Recent discoveries on gene expression and a better understanding of the etiopathogenesis of SS may open new treatment options in the future.
Collapse
|
32
|
Moen K, Kvalvik AG, Hellem S, Jonsson R, Brun JG. The long-term effect of anti TNF-α treatment on temporomandibular joints, oral mucosa, and salivary flow in patients with active rheumatoid arthritis: A pilot study. ACTA ACUST UNITED AC 2005; 100:433-40. [PMID: 16182164 DOI: 10.1016/j.tripleo.2005.05.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Revised: 05/03/2005] [Accepted: 05/23/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the long-term effects of anti-TNF-alpha treatment on temporomandibular joints (TMJs), oral mucosa, and salivary flow in RA. STUDY DESIGN Seventeen patients received infusions of TNF-alpha blocking agents after 0, 2, and 6 weeks, and then every 8 weeks until week 54 (follow-up). Clinical dysfunction index (Di) for the TMJ system, salivary flow, disease activity score (DAS28), and other medical assessments were calculated at weeks 0 and 54. RESULTS Median Di was 5.0 (range 0-21) at baseline and 1.0 (range 0-6) (P = .001) at follow-up. Mean salivary flow was 3.2 mL/15 minutes at baseline and 4.6 at follow-up (P = .055). Two (11.7%) of the patients developed oral candidiasis during the period of treatment. The median DAS28 was 6.2 (range, 4.7-7.7) at baseline and 4.1 (range, 1.6-6.8) at follow-up (P = .001). CONCLUSION We conclude that anti-TNF-alpha blocking treatments have beneficial effects on oral as well as general manifestations of RA.
Collapse
Affiliation(s)
- Ketil Moen
- Broegelmann Research Laboratory, The Gade Institute, University of Bergen, Norway.
| | | | | | | | | |
Collapse
|