Evaluation of the Temporomandibular Joint by Ultrasound Before and After Local Treatment in Rheumatoid Arthritis Patients

Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease with an incidence of 54 per 100,000 in women and 24.5 per 100,000 in men characterized by articular and extra articular involvement. The disease predominantly affects small joints in the hands, wrists and feet, but may involve any joint lined by a synovial membrane (Moen et al., 2005). Temporomandibular joint (TMJ) is commonly involved in RA patients which is characterized by pain, tenderness, swelling and limited mandibular movement. Clicking of the TMJ may occur. Masticatory dysfunction and trismus can occur in severe affection of the TMJ (Uchiyama et al., 2013). The reported prevalence of TMJ involvement in RA varies widely from 4.7–88% (Lin et al., 2007). In another study on Egyptian RA patients, TMJ involvement was present in 70.8% and the most commonly seen clinical dysfunction manifestations were difficult manipulation and pain, tenderness, clicking, locking and altered mouth opening (El-Melegy et al., 2017). Different imaging techniques are used for TMJ evaluation. Conventional radiography is traditionally the first step in the radiologic Evaluation (Melchiorre et al., 2003). Magnetic resonance imaging (MRI) has been considered an accurate method to examine disc position, configuration, attachment,