Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study.

OBJECTIVES: To investigate subjective, clinical and radiographic findings relating to the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA), mixed connective tissue disease (MCTD), ankylosing spondylitis (AS), and spondyloarthropathy (SPA), and to compare the findings with those in age- and sex-matched control subjects.

STUDY DESIGN: Eighty patients (24 with RA, 16 with MCTD, 19 with AS, 21 with SPA) and 80 matched controls participated in the study. Replies to a questionnaire covering oral and TMJ symptoms were analysed in conjunction with medical histories, results of clinical examination of the stomatognathic system, and panoramic and lateral panoramic radiographs.

RESULTS: Patients with rheumatic disease reported severe TMJ symptoms significantly oftener than control subjects (P < .001). Patients with AS reported symptoms most frequently (7/19, 37%). Mean maximal opening of the mouth (SD) was significantly less in patients with rheumatic disease (46.3 mm (8.6 mm)) than in control subjects (55.0 mm (7.4 mm)) (P < .001). Marked erosions were observed in 4 RA patients (17%), 3 MCTD patients (19%), 8 SPA patients (38%), 7 AS patients (37%), and 1 control subject (1%) (P < .001). The existence of erosion was associated with evidence of restricted movement of condyle in panoramic radiographs (P < .001). There was correlation between radiographic findings relating to the TMJ and subjective and clinical stomatognathic-system symptoms in patients with rheumatic disease. Subjective TMJ symptoms were associated with evidence of restricted movement of condyle in panoramic radiographs (P < .001). Impairment of laterotrusion movement was significantly associated with erosion (P < .001).

CONCLUSIONS: The TMJ is commonly affected in patients with RA, and in patients with other forms of rheumatic disease. There are associations between radiographic findings and subjective symptoms, and between radiographic findings and restricted TMJ movement. In screening for suspected TMJ destruction, it would be appropriate to look for restricted maximal mouth opening, masticatory muscle tenderness and restricted laterotrusion.