Evaluation of the Prevalence of Temporomandibular Joint Involvement in Rheumatoid Arthritis Using Research Diagnostic Criteria for Temporomandibular Disorders
AbstractObjectives: Temporomandibular joint (TMJ) disorders, known as TMDs, are significant public health problems and may result in pain and disability. In order to determine the prevalence of clinical/subjective TMD in rheumatoid arthritis (RA), we used the research diagnostic criteria (RDC)/TMD axes. We assessed the anti-cyclic citrullinated protein (anti-CCP)-related TMD in RA for the first time. Materials and Methods: Fifty-two RA patients were compared to 47 healthy controls with regard to complete blood count (CBC), serology, acute phase reactants (APR), and TMJ dysfunction. Results: The anti-CCP antibody showed a significant correlation with the development of clinical TMD (P=0.001, 95% confidence interval (CI)=12.4%-35.6%). A prevalence of 50% was calculated through the RDC/TMD for such disorders. In RA patients, statistically significant differences were observed between the groups with and without clinical TMD regarding psychological depression and physical symptoms. Conclusions: According to the results, a significant correlation was found between the anti-CCP antibody and TMD. Therefore, when this antibody is detected in the blood serum, the treatment must be initiated. The RDC/TMD used in this study assessed the prevalence of TMJ dysfunction in conformity with RA-associated TMJ findings previously obtained through other conventional methods.
Shah A, Clair EW. Rheumatoid Arthritis In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J, editor. Harrison’s principles of internal medicine. 19th ed. New York: Mc Graw Hill; 2015. P. 2136-2149, 2216-25.
Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E. Diagnosis and classification of rheumatoid arthritis. J Autoimmun 2014;48-49:26-30.
Lin YC, Hsu ML, Yang JS, Liang TH, Chou SL, Lin HY. Temporomandibular joint disorders in patients with rheumatoid arthritis. J Chin Med Assoc 2007;70(12):527-34.
Hajati AK, Alstergren P, Näsström K, Bratt J, Kopp S. Endogenous glutamate in association with inflammatory and hormonal factors modulates bone tissue resorption of the temporomandibular joint in patients with early rheumatoid arthritis. J Oral Maxillofac Surg 2009;67(9):1895-903.
Ahmed N, Mustafa HM, Catrina AI, Alstergren P. Impact of temporomandibular joint pain in rheumatoid arthritis. Mediators Inflamm 2013;2013:597419.
Larheim TA, Sano T, Yotsui Y. Clinical Significance of Changes in the Bone Marrow and Intra-Articular Soft Tissues of the Temporomandibular Joint. Semin Orthod 2012;18(1):30-43.
Aceves-Avila FJ, Chávez-López M, Chavira-González JR, Ramos-Remus C. Temporomandibular joint dysfunction in various rheumatic diseases. Reumatismo 2013;65:126-30.
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:453-62.
Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28(1):6-27.
Moen K, Bertelsen LT, Hellem S, Jonsson R, Brun JG. Salivary gland and temporomandibular joint involvement in rheumatoid arthritis: relation to disease activity. Oral Dis 2005;11:27-34.
John MT, Dworkin SF, Mancl LA. Reliability of clinical temporomandibular disorder diagnoses. Pain 2005;118:61-9.
Kim YK, Kim SG, Im JH, Yun PY. Clinical survey of the patients with temporomandibular joint disorders, using Research Diagnostic Criteria (Axis II) for TMD: preliminary study. J Craniomaxillofac Surg 2012;40(4):366-72.
McNally E, Keogh C, Galvin R, Fahey T. Diagnostic accuracy of a clinical prediction rule (CPR) for identifying patients with recent-onset undifferentiated arthritis who are at a high risk of developing rheumatoid arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014;43:498-507.
Block DR, Jenkins SM, Dalenberg DA, Balsanek JG, Snyder MR, Saenger AK. Analytical and clinical comparison of anti-CCP assays with rheumatoid factor for the diagnosis of rheumatoid arthritis. Clin Chim Acta 2012;413:1015-7.
Nijenhuis S, Zendman AJ, Vossenaar ER, Pruijn GJ, vanVenrooij WJ. Autoantibodies to citrullinated proteins in rheumatoid arthritis: clinical performance and biochemical aspects of an RA-specific marker. Clin Chim Acta 2004;350(1-2):17-34.
Vossenaar ER, van Venrooij WJ. Anti-CCP antibodies, a highly specific marker for (early) rheumatoid arthritis. Clin Appl Immunol Rev 2004;4(2004):239-62.
Svärd A, Kastbom A, Sommarin Y, Skogh T. Salivary IgA antibodies to cyclic citrullinated peptides (CCP) in rheumatoid arthritis. Immunobiology 2013;218(2):232-7.
Helenius LM, Hallikainen D, Helenius I, Meurman JH, Könönen M, Leirisalo-Repo M, et al. Salivary IgA antibodies to cyclic citrullinated peptides (CCP) in rheumatoid arthritis. Immunobiology 2013;218(2):232-7.
Garib BT, Qaradaxi SS. Temporomandibular joint problems and periodontal condition in rheumatoid arthritis patients in relation to their rheumatologic status. J Oral Maxillofac Surg 2011;69:2971-8.
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(7):704-9.
Humphris G and Ling MS. Behavioural Sciences for Dentistry. Edinburgh: Churchill Livingstone; 2000:103-15.
Teruel A, Broussard JS Jr, Clark GT. Temporomandibular Joint Arthritis: Implications, diagnosis and management. In: Clark GT and Dionne RA, editor. Orofacial Pain; A guide to medications and management. Wiley-Blackwell; 2012. P. 311-22.