Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Rheumatol Int. 2020 Jun;40(6):933-940. doi: 10.1007/s00296-020-04563-y. Epub 2020 Apr 1.
There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on ankylosing spondylitis (AS) and TMD relationship. We conducted this study to test the predictors of TMD in AS patients and its relationship with craniocervical posture. AS patients aged between 18 and 50 years consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)'. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. Craniocervical posture was assessed on lateral cervical X-ray by measuring the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, and anterior translation distance. A total of 98 (58.2% female) patients with a mean age of 37.4 ± 8.2 years were enrolled in this study. TMD was diagnosed in 58 (59.2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups. Smoking, bruxism (in females), neck disability and AS disease activity (in males) were higher in TMD patients. Multivariate analysis revealed active smoking (aOR 6.9; 95% CI 1.8-25.6; p = 0.004), bruxism in females (aOR 17.9; 95% CI 2.0-159.2; p = 0.01), high ASDAS in males (aOR 11.8; 95% CI 1.2-122.5; p = 0.038) and neck disability (aOR 12.7; 95% CI 3.8-42.9; p < 0.001) as independent risk factors for TMD in AS patients. No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients.
关于颅颈姿势的客观决定因素与颞下颌关节紊乱（TMD）之间的关系，相关文献中有相互矛盾的结果，而尚无研究涉及强直性脊柱炎（AS）与 TMD 的关系。我们进行这项研究是为了检验 AS 患者 TMD 的预测因素及其与颅颈姿势的关系。我们连续招募了年龄在 18 至 50 岁之间的门诊 AS 患者。TMD 通过“颞下颌关节紊乱诊断标准（DC/TMD）”进行诊断。脊柱活动度通过 BASMI 进行评估；疾病活动度通过 ASDAS-CRP 评估，颈部残疾通过颈部残疾指数（NDI）评估。颅颈姿势通过测量颅颈角、颈椎曲度角、枕下距离、寰枢椎距离和寰枢椎前移位距离，在侧位颈椎 X 线片上进行评估。这项研究共纳入了 98 名（58.2%为女性）平均年龄为 37.4±8.2 岁的患者。58 名（59.2%）患者被诊断为 TMD。两组患者的脊柱活动度和颅颈姿势测量值相似。TMD 患者的吸烟、磨牙症（女性）、颈部残疾和 AS 疾病活动度（男性）更高。多变量分析显示，吸烟（OR 6.9；95%CI 1.8-25.6；p=0.004）、女性磨牙症（OR 17.9；95%CI 2.0-159.2；p=0.01）、男性 AS 疾病活动度高（OR 11.8；95%CI 1.2-122.5；p=0.038）和颈部残疾（OR 12.7；95%CI 3.8-42.9；p<0.001）是 AS 患者 TMD 的独立危险因素。AS 患者的颅颈姿势测量值与 TMD 之间无相关性。吸烟、男性疾病活动度高、女性磨牙症和颈部残疾是 AS 患者 TMD 的预测因素。
