Temporomandibular Joint Disorders
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Many of the inflammatory arthropathies can affect the TMJ.12 Rheumatoid disease can occur in the child, adolescent and adult. It will usually present with the signs and symptoms of synovitis, namely pain, swelling, heat and restriction of movement, and therefore can be difficult to differentiate from infective causes. Progression can lead to joint collapse resulting in malocclusion with an anterior open bite and a retrusive chin (see Figure 57.3). Usually other joints, particularly the hands and feet, will have been involved for some time, as rheumatoid disease is a polyarticular arthropathy tending to affect the smaller joints. Diagnosis can be confirmed serologically with a positive rheumatoid factor present in 80%. Sero-negative arthropathy can occur with a similar clinical picture. In the head and neck there can be associated dry mouth, dry eyes (Sjögren’s syndrome) and difficulty with oral hygiene due to involvement of the hands.
Thermal Imaging for Inflammatory Arthritis Evaluation
U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer in Artificial Intelligence-Based Infrared Thermal Image Processing and Its Applications, 2023
RA is an inflammatory multi-factorial systemic disorder that affects around 1–2% of Indians, especially women in the age group of 50-year-olds (Mittal and Dubey, 2013). It causes pain, disability, and loss of function. Earlier screening or diagnosis of RA allows better treatment and prevention. Unfortunately, there is no specific test to detect the presence of RA. RA is traditionally diagnosed by combining symptoms such as morning stiffness with clinical signs such as a number of swollen and tender joints and laboratory tests such as ESR, CRP, rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibodies. For the diagnosis of RA, clinical signs and symptoms must have been present for at least 6 weeks (Arnett et al., 1988). The severity of disease can be further assessed by imaging modalities such as X-ray, ultrasound, and MRI. However, the sensitivity of these tests is limited in the diagnosis of RA at the earlier stage (Heidari, 2011). In 2010, the American College of Rheumatology/European League against Rheumatism Collaborative Initiative published revised rheumatoid arthritis classification criteria aimed at earliest identification of patients who might benefit from treatment with disease-modifying anti-rheumatic drugs (DMARD). The presence of obvious “clinical” synovitis in at least one joint is central to this classification (Aletaha et al., 2010). Imaging techniques such as MRI or sonography can confirm clinically suspected synovitis.
Selected topics
Henry J. Woodford in Essential Geriatrics, 2022
Rheumatoid factor (RF) is positive in around 66% of people with later onset RA, compared to 80–90% of those with younger onset disease.27 It may also be weakly positive in a number of healthy older people. Anti-cyclic citrullinated peptide (anti-CCP) antibodies are an alternative diagnostic test. They are also present in around two thirds of those with RA, but less common outside this condition.27 ESR is characteristically elevated. The differential diagnosis includes polymyalgia rheumatica (see page 431). Synovitis may be seen in the hands, usually affecting the wrists, proximal interphalangeal and metacarpal phalangeal joints. X-rays may show erosive changes (typically juxta-articular) and joint space narrowing. Ultrasound assessments can detect subclinical synovitis to aid assessment.
Identifying the response process validity of clinical vignette-type multiple choice questions: An eye-tracking study
Published in Medical Teacher, 2023
Francisco Carlos Specian Junior, Thiago Martins Santos, John Sandars, Eliana Martorano Amaral, Dario Cecilio-Fernandes
Boy, three-year-old, was brought to the Emergency Room with pain in the right lower limb and difficulty in walking for one day. Family history: brother with an upper respiratory tract infection for 10 days. Physical examination: T = 36.8 °C; RR = 16 breaths per minute; HR = 90 beats per minute; Limbs: limitation of internal and external rotation of the right hip; does not perform complete extension of the right lower limb. The most likely diagnosis is:Rheumatic fever.Legg-Calve-Perthes disease.Transient synovitis.Juvenile idiopathic arthritis.
Intra-articular injection of triamcinolone acetonide releasing biomaterial microspheres inhibits pain and inflammation in an acute arthritis model
Published in Drug Delivery, 2019
Imke Rudnik-Jansen, Karin Schrijver, Nina Woike, Anna Tellegen, Sabine Versteeg, Pieter Emans, George Mihov, Jens Thies, Niels Eijkelkamp, Marianna Tryfonidou, Laura Creemers
Osteoarthritis (OA) is the most common form of arthritis, affecting people worldwide, with rising prevalence (March et al., 2014). This degenerative joint disease is characterized by cartilage breakdown, fibrotic changes to the joint capsule, bony changes, and inflammation of the synovial membrane (Samuels et al., 2008). These phenomena result in pain and reduced mobility, thereby negatively affecting the quality of life in OA patients. An important feature and source of pain in both OA and many other joint pathologies is synovial inflammation, or synovitis. Synovitis causes joint pain (Hill et al., 2007; Ishijima et al., 2011) and is characterized by synovial hypertrophy, increased neovascularization and influx of immune cell infiltrates that secrete pro-inflammatory mediators (Smith et al., 1997; Krenn et al., 2006). In addition to triggering several clinical signs, it can extend cartilage breakdown (Sellam & Berenbaum, 2010). Targeting synovial inflammation is, therefore, an important treatment strategy in OA patients.
Detection of synovial inflammation in rheumatic diseases using superb microvascular imaging: Comparison with conventional power Doppler imaging
Published in Modern Rheumatology, 2018
Kazuhiro Yokota, Takuma Tsuzuki Wada, Yuji Akiyama, Toshihide Mimura
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic and destructive inflammation of the joints. In the clinical course of RA, progressive multiple joint destruction leads to severe disability and shortening of life expectancy. Regarding clinical practice, detection of synovitis is indispensable for early and precise diagnosis, evaluation of disease activity, treatment response, and prognosis prediction [1]. Ultrasonography, a non-invasive imaging evaluation method, is highly useful and more sensitive than a clinical joint examination in detecting synovitis [2]. Conventional power Doppler (PD) imaging (cPDI) can visualize ongoing active synovitis by revealing abnormal blood flow, with a focus on vascularization and vasodilatation within synovial hypertrophy [3]. In addition, detecting active synovitis using cPDI is associated with diagnosis and enables prediction of progression of joint destruction [2–5]. Additionally, PD-detected synovitis has been correlated with the risk for clinical relapse and failed tapering of biologics therapy [6].
Related Knowledge Centers
- Inflammation
- Synovial Joint
- Synovial Membrane
- Arthritis
- Osteoarthritis
- Joint
- Gout
- Synovial Fluid
- Lupus Erythematosus
- Rheumatoid Arthritis