Evaluation of the Involvement of the Tempromandibular Joint in Patients with Psoriasis using Computed Tomography for Detection of Psoriatic Arthritis Changes

Abstract

Background: Tempromandibular disorders is a collective term, embracing several clinical roblems involving the muscles of mastica- tion, temporomandibular joint (TMJ), or both. Tempromandibular disorders is a symptom complex rather than a single condition. TMDs form a cluster of related disorders with common symptoms which include localized pain, limited or asymmetric movement, and clicks or grating on opening.Psoriatic arthritis is a chronic inflammatory arthropathy that affects patients with psoriasis. The clinical findings for Tempromandibular PSA are pain, tenderness, limitation of movement , joint stiffness, clicking as the jaw is opened or closed, difficulty in opening the mouth, locking of the jaw,and crepitations. These findings are essentially the same as for myofascial pain/dysfunction(3). The objective of the study were to determine the extent of tempromandibular joint involve- ment in patients with psoriatic arthritis and to evaluate the correlation between clinical findings and radiographic finding. Materials and method: In this study 98 patients were selected ,50 male and 48 female, their age ranged between(18-68)years. They were collected at Al –yarmook teaching hospital/department of.They were diagnosed as having psoriatic arthritis by a derma- tologist according to (Moll and Wright diagnostic criteria 1973)(11).These patients were subjected to rheumatoid factor test RF to exclude the presence of rheumatoid arthritic disease, then the patients were exposed to CT scanning for the Tempromandibular joint in Al-Yarmook teaching hospital for screening the involvement of TMJ with psoriatic arthritis by the presence of any radio- graphic changes such as erosion, flattening,osteophyte and sclerosis in the condylar head.

Results: The result of the study showed that the mean age of psoriatic arthritic patients in TMJ was (44.2) years, and female per- centage was (48.4%) and male was(51.6%). Psoriatic arthritis in TMJ showed high significance in the unilateral side complaining (100%) and itwas significant in the positive family history (54.8%), and non significant in the right/left ratio (41.9%). Oligo type was found in twenty six patients (83.9%) with significant p-value. Clinically: all symptoms including clicking, tenderness and temproma- dibular joint pain were highly significant, limitation showed (54.8%), TMJ pain showed (64.5%) and tenderness showed (54.8%). Radiologically: CT scan showed sensitivity for erosion in TMJ (54.8%), for osteophyte (32.3%), for condylar flattening (16.1%) and for sclerosis (9.7%) while specificity for all were (100%). Association between clinical and radiological changes showed non significant correlation.

Conclusions: Psoriatic arthritis of TMJ is unilateral (oligo type).Female/ male ratio is about 1:1. About 50% of patients have lim- itation in mouth opening. Most of the patients have positive family history. Duration of the disease is related to the development of psoriatic arthritis in TMJ. Plaque psoriasis is the most associated type with the psoriatic arthritis in TMJ. Most of patients with psoriatic arthritis show psoriatic nail changes. The most radiographic findings found in patients with psoritic arthritis was erosion in the condylar head. There is association between clinical and radiologic findings for psoriatic arthritis in TMJ.