Department of Dentistry and Oral Medicine, School of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea.
Department of Oral Medicine, Seoul National University Dental Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Head Face Med. 2018 Nov 22;14(1):26. doi: 10.1186/s13005-018-0183-3.
To investigate the differences in clinical characteristics and long-term treatment outcomes according to antinuclear antibody(ANA) and rheumatoid factor(RF) positivity and the correlation between pain-related and hematological indices in temporomandibular disorders(TMD) patients.
Clinical examinations were done following the Research Diagnostic Criteria for TMD in 257 patients. Comprehensive screening along with psychological and hematological evaluations (ANA, RF, complete blood cell count, C-reactive protein[CRP] and erythrocyte sedimentation rate[ESR]) were conducted. Clinical characteristics and treatment outcomes were statistically compared between ANA/RF positive and negative groups.
Thirty-nine patients showed ANA/RF positivity. Male patients had smaller comfortable mouth opening(CMO)(p = 0.033) and maximum mouth opening(MMO)(p = 0.016) ranges with more painful neck muscles on palpation when RF/ANA positive. Pain duration, intensity, disability days and psychological distress levels were also higher in RF/ANA positive male patients. Significant correlation was shown in ESR with pain duration(p < 0.05) and numeric rating scale(NRS) before treatment(p < 0.05), CRP with NRS before treatment(p < 0.01), and red blood cell (RBC) with pain intensity(p < 0.05), NRS before treatment(p < 0.01), CMO(p < 0.01), pain on palpation of cervical muscles(p < 0.01), CMO(p < 0.05), and MMO(p < 0.05) 6 months after treatment.
These results may point towards a nonspecific autoimmune disposition in a subgroup of TMD patients. RF and ANA could be considered as a screening test for the detection of autoimmune phenomena in TMD.
本研究旨在探讨抗核抗体（ANA）和类风湿因子（RF）阳性的颞下颌关节紊乱病（TMD）患者的临床特征和长期治疗结果的差异，以及疼痛相关和血液学指标之间的相关性。
对 257 例 TMD 患者采用研究诊断标准进行临床检查。对患者进行全面筛查，并进行心理和血液学评估（ANA、RF、全血细胞计数、C 反应蛋白[CRP]和红细胞沉降率[ESR]）。对 ANA/RF 阳性和阴性组的临床特征和治疗结果进行统计学比较。
39 例患者 ANA/RF 阳性。RF/ANA 阳性的男性患者张口度（CMO）和最大张口度（MMO）较小（p=0.033，p=0.016），触诊颈肌时疼痛更明显。RF/ANA 阳性的男性患者疼痛持续时间、疼痛强度、残疾天数和心理困扰程度也更高。ESR 与疼痛持续时间（p<0.05）和治疗前数字评定量表（NRS）评分（p<0.05）、CRP 与治疗前 NRS 评分（p<0.01）、红细胞（RBC）与疼痛强度（p<0.05）、治疗前 NRS 评分（p<0.01）、CMO（p<0.01）、颈肌触诊时疼痛（p<0.01）、CMO（p<0.05）和 MMO（p<0.05）在治疗后 6 个月时有显著相关性。
这些结果可能表明 TMD 患者亚组存在非特异性自身免疫倾向。RF 和 ANA 可作为 TMD 自身免疫现象检测的筛选试验。
