Inflammation of the jaw joint

Inflammation of any joint is called arthritis, inflammation of the jaw joint is arthritis of the temporomandibular joint that connects the lower jaw to the temporal bone of the skull base. [1]

Epidemiology

The prevalence of various forms of temporomandibular joint disorders in the adult population is estimated at 5-12%, and they are twice as common in women.

In adults and children with rheumatoid arthritis, the jaw joint is affected in 17-26% of cases, although complaints about this joint are present in more than half of patients.

Causes of the inflammation of the jaw joint

It should be noted that the shapes and sizes of the articular surfaces that articulate in temporomandibular joint - the articular head of the mandible (at the end of its condyle) covered with fibrous cartilage, the mandibular fossa of the temporal bone and the articular tubercle of its zygomatic process - do not correspond to each other, so this joint is incongruent. The presence of a cartilaginous articular disk between the head of the mandible and the articular surface of the temporal bone allows this joint to move in the vertical, sagittal, and transversal axes.

The causes of inflammation of the jaw (temporomandibular or TMJ) may be related to the development of inflammatory arthropathy or may be secondary to its dysfunction - disorders of the temporomandibular joint.

The main types are distinguished as: infectious (bacterial) or septic arthritis, traumatic arthritis and rheumatoid arthritis of the temporomandibular joint.

Temporomandibular joint infection occurs as a result of local dissemination or hematogenous spread of pathogenic bacteria (Staphylococcus aureus, Streptococcus, Pseudomonas aeruginosa, Haemophilus influenzae) from the primary focus into the well-vascularized synovial membrane of the joint and then into its capsule. Distant primary foci can be: chronic purulent otitis media, empyema of the mastoid process of the temporal bone (mastoiditis), lymphadenitis (inflammation of lymph nodes) of the face and neck, odontogenic purulent inflammation of the periosteum of the jaw (periostitis) or chronic odontogenic osteomyelitis.

In rare cases, acute trauma to the ear, fracture or injury to the lower jaw, difficult removal of mandibular molars or wisdom tooth, and tracheal intubation can lead to traumatic arthritis of the jaw joint.

The temporomandibular joint is also affected by rheumatoid arthritis, including juvenile rheumatoid arthritis (which for unknown reasons manifests before the age of 16) - with other signs typical of the disease. But very rarely does it occur in the early stages of the disease. [2]

Risk factors

The main risk factors for jaw joint inflammation (infectious, traumatic and rheumatoid arthritis) are considered to be:

• Injuries (fractures, wounds, burn wounds) to the jaw and temporal bone;
• tooth extraction and teeth grinding in your sleep - bruxism;
• Temporomandibular joint disorders (including muscle pain and jaw dysfunction - with a variety of clinical signs and symptoms affecting the masticatory muscles, teeth, tongue, temporomandibular joint and/or supporting tissues);
• pre-existing joint disease;
• systemic and autoimmune diseases (SLE, polyarthritis);
• weak immune system, immunosuppression-related diabetes and alcoholism, and long-term use of systemic corticosteroids.

Pathogenesis

The mechanism of development of the inflammatory process depends on its etiology.

In the case of infectious (septic) arthritis, the pathogenesis is associated with the penetration of pathogens into the joint and their rapid multiplication, after which - as a result of their adhesion to glycoproteins of plasma and extracellular matrix - there is an activation of the complex of protective blood proteins (complement system), humoral and adaptive immunity with the development of an acute inflammatory reaction.

Endothelial cells and synovial fibroblasts release inflammatory cytokines (IL-1, IL-6), extracellular tumor necrosis factor (TNF-α) and nitric oxide into the synovial membrane with migration of leukocytes (neutrophils and macrophages) to the site of injury. Further phagocytosis of the infectious agent occurs, but due to the influx of inflammatory cells into the synovial membrane there may be damage to cartilage and bone with possible destruction of the joint.

In autoimmune inflammatory arthropathies - rheumatoid arthritis - the neutrophilic inflammatory cascade is due to the activation of the immune system, which perceives its own cells as antigens and "attacks" the healthy tissues lining the joints. Both jaw joints may be affected.

Symptoms of the inflammation of the jaw joint

The first signs of inflammation of the jaw joint are its stiffness after long periods of rest and stiffness.

Infectious (septic) arthritis of the temporomandibular joint is manifested by fever, swelling and hyperemia of the surrounding soft tissues, impaired skin sensitivity in the area of the joint, pain (which increases when pressing and trying to open the mouth), trismus (limited opening of the mouth), acute bite disorder.

Purulent septic arthritis is characterized by dizziness, masses in the joint area, and narrowing of the external auditory canal with hearing impairment.

In traumatic arthritis, symptoms include pain and restricted mobility of the lower jaw.

In rheumatoid arthritis of the TMJ, patients complain of: pain in the jaw (as well as in the ears, neck or eyes), stiffness in the jaw joint, limited range of motion of the lower jaw, and creaking or crunching in the joint. People with rheumatoid arthritis of the jaw usually experience symptoms of the disease in other joints before they feel it in the jaw joint. In addition, rheumatoid arthritis can cause symptoms outside the joints, such as fatigue, fever, and loss of appetite. [3]

Complications and consequences

Septic arthritis of the jaw joint can give complications in the form of such secondary degenerative changes as destruction of the articular surfaces of the joint, narrowing of the joint gap, formation of marginal osteophytes, as well as fibrous or bony fusion of the articular surfaces - temporomandibular joint ankylosis.

Rheumatoid arthritis of the jaw joint in childhood can cause bone destruction, erosive changes of the joint with destruction of the mandibular condyle, which leads to impaired growth of the mandible, malocclusion in the anterior region and facial deformity. The key negative consequences in adults (if not treated in time) are tinnitus and dental problems, including accelerated tooth wear.

Diagnostics of the inflammation of the jaw joint

Based on the clinical picture, imaging data and laboratory tests, an accurate diagnosis of temporomandibular joint inflammation is made.

Instrumental diagnosis consists of panoramic X-rays of the mandible, computed tomography and MRI of the temporomandibular joint. Early lesions of the joint in rheumatoid arthritis can only be visualized with cone beam computed tomography.

See - X-ray diagnosis of temporomandibular joint disorders

The following tests are necessary: general blood count, COE, for C-reactive protein, rheumatoid factor in blood, antibody level. Aspiration of synovial fluid and its bacteriologic culture are also performed.

Differential diagnosis

The differential diagnosis includes fracture, ostitis, and osteomyelitis of the jaw; hypertrophic mandibular condyle; synovial chondromatosis; neuralgia of the facial or superior laryngeal nerve; musculofacial pain syndrome, temporomandibular joint dysfunction (Kosten's syndrome), salivary gland inflammation, and neoplasms.

Treatment of the inflammation of the jaw joint

Antibiotics for inflammation of the jaw joint - Ceftriaxone, Vancomycin, Benzylpenicillin (Penicillin G sodium salt) and others. - are used parenterally when infectious (septic) arthritis is diagnosed. For more information, see. - Antibiotics for the treatment of arthritis

The abscesses are aspirated and drained, and once the infection is under control, active mouth opening exercises are performed to prevent scarring and limit jaw mobility.

Medications for pain and inflammation (orally and by injection) are non-steroidal anti-inflammatory drugs (NSAIDs): Diclofenac sodium (Naclofen), Ibuprofen, Indomethacin, Celecoxib, Ketoprofen, etc.

Read also:

• Arthritis pills
• Drugs for joint pain

Treatment of rheumatoid arthritis of the jaw joint is similar to treatment of rheumatoid arthritis of other joints - using disease-modifying antirheumatic drugs (Methotrexate, Leflunomide, Sulfalazine, etc.) and drugs containing TNF-α inhibitor monoclonal antibodies (Rituximab, Abatacept, etc.).

• For more information see. - Rheumatoid arthritis: treatment

Traumatic arthritis of this joint is treated with systemic corticosteroids - orally or in the form of intra-articular injections; take NSAIDs, make hot or cold compresses.

Physiotherapeutic treatment is used: ultraphonophoresis, electromyostimulation, shockwave therapy. More information in the article - Physiotherapy for joint diseases

If drug therapy does not produce the desired result, surgical treatment is used, such as arthrocentesis, arthroscopy (during which the joint capsule is washed, the disc is repaired, exostoses are removed, etc.), condylotomy (opening) of the articular head of the mandible, open joint surgery (arthrotomy), TMJ arthroplasty. [4]

Prevention

In the case of inflammation of the jaw joints, there are no special preventive measures, and it is not always possible to prevent it, for example, in rheumatoid arthritis.

Experts recommend using a mouth guard at night if you clench your jaws or grind your teeth in your sleep.

Forecast

For some, temporomandibular joint arthritis is a temporary problem that disappears after treatment. But for others, it is a chronic condition that negatively affects the quality of life. However, it should be kept in mind that significantly improves the prognosis. Inflammation of the jaw joint its early diagnosis and timely treatment.