AB0350 Temporo-mandibular joint involvement in rheumatoid arthritis

Abstract

Background Temporomandibular joint (TMJ) disorder in rheumatoid arthritis (RA) may be associated with significant osteoarticular destruction and may be responsible of significant functional impairment. Objectives We aimed in this study to determine the prevalence of TMJ involvement and its correlations with RA parameters. Methods We report a descriptive monocentric cross-sectional study of 90 consecutive RA, followed at the Rheumatology department of Monastir Teaching Hospital in Tunisia, during 06 months (November 2016 to April 2017) and 46 matched volunteers. Clinical assessment and stomatological examination were performed in all cases. Results Sixty-three RA patients out of 90 (70%) had TMJ involvement. TMJ painful mobilisation, mastication difficulties, swollen TMJ, dental malocclusion and limitation of mouth opening were noted in 55 (81%), 49 (74%), 20 (30.3%), 19 (29%) and 8 (12%) of cases, respectively. Compared with the control group, painful palpation of TMJ (p<0.000) was significantly associated with RA. In RA, TMJ disorder is more common in adults between 40 and 60 years of age, patients with HAQ>0.5 and a high total Vander Heijde Sharp radiographic score (SS). TMJ painful mobilisation is significantly associated with increased body mass index (BMI). Swollen TMJ is significantly associated with age (more frequent in elderly subjects), increased BMI, high RA disease activity (high DAS 28 ESR and/or DAS 28 CRP) and HAQ>0.5. Limitation of mouth opening is significantly associated with age (more common in elderly subjects), overweight, high methotrexate dose (20 mg/day), leflunomide and biotherapy use. Dental malocclusion was significantly associated with high doses corticosteroids (more than 5 mg/day). Mastication difficulties are significantly associated with more than 10 year RA duration, HAQ>0.5 and radiological impairment. Conclusions Temporomandibular disorder is frequent in RA (70%). TMJ disorder is observed especially in active (high DAS 28), serious (radiological impairment, HAQ>0.5) and advanced (more than 10 year duration) RA. Physicians must be careful to assess systematically TMJ in RA patients. Reference [1] Aliko A, Ciancaglini R, Alushi A, Tafaj A, Ruci D. Temporomandibular joint involvement in rheumatoid arthritis, systemic lupus erythematosus and systemic sclerosis. International Journal of Oral and Maxillofacial Surgery2011;40:704–9. Disclosure of Interest None declared