A Female Psoriatic Arthritis Patient Involving the TMJ

Temporomandibular Joint Involvement Revealing Psoriatic Arthritis: A Case Report

Temporomandibular joint (TMJ) involvement in psoriatic arthritis (PsA) is infrequent but can lead to significant pain and challenges in effective mouth opening or closing. In this report, we present a clinical case of a patient with TMJ involvement revealing PsA.  The patient is a 35-year-old male with a history of guttate psoriasis, who presented with several weeks of TMJ pain and decreased mouth opening, followed by inflammatory lumbar, buttock pain and oligoarthritis. The diagnosis of PsA with TMJ involvement was established based on clinical manifestations per the ClASsification criteria for Psoriatic ARthritis (CASPAR) criteria. Full remission was achieved with tumor necrosis factor alpha inhibitors. Frequently overlooked or untreated, delayed diagnosis contributes to extensive deterioration of TMJ structures, resulting in persistent discomfort and a detrimental impact on the patient's quality of life. Therefore, prompt initiation of appropriate treatment is crucial to enhance patient well-being.

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study.