Division of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy.
Department of Cranio-Maxillofacial Surgery, Unit of Cranio-Maxillofacial Surgery, University of Ferrara, Italy.
Clin Exp Rheumatol. 2024 Jan;42(1):39-47. doi: 10.55563/clinexprheumatol/pfi2ql. Epub 2023 Aug 3.
To evaluate the prevalence of temporomandibular disorders (TMD) in a monocentric cohort of patients affected by psoriatic arthritis (PsA), and to investigate the accuracy of temporomandibular joint (TMJ) ultrasound (US) compared with clinical evaluation and clinimetric composite index in assessing TMJ involvement.
We conducted a prospective cohort study of patients diagnosed with PsA who underwent at least one TMJ US examination and maxillofacial surgeon's evaluation between 2018 and 2021. The rheumatology physician's interpretation of each TMJ US exam (presence/absence of TMD) was compared with psoriatic arthritis disease activity indexes and maxillofacial surgeon's clinical judgement (presence/absence of TMD signs and/or symptoms).
142 psoriatic arthritis patients were included. 111 patients were totally asymptomatic for TMD, but 58.5% of them already showed TMJ US changes; moreover, 103 patients passed the maxillofacial surgeon's examination in the absence of any relevant findings but again, of these, 55.3% already presented US signs of TMD. Univariate analysis of subgroups with and without TMJ synovitis and with and without active power Doppler signal showed a significant prevalence of peripheral enthesitic involvement in patients affected by TMD (95.7% vs. 4.3%, p=0.001; and 72.2% vs. 27.3%, p=0.007, respectively). Multivariate regression analysis confirmed the results (p=0.01 and p=0.013, respectively).
Peripheral enthesitic involvement may represent a potential risk factor for the development of TMJ synovitis in PsA patients. Since TMD often develops asymptomatically, TMJ US may detect early signs of TMD, ensuring precocious and adequate management.
评估颞下颌关节紊乱病（TMD）在患有银屑病关节炎（PsA）的单中心患者队列中的患病率，并探讨颞下颌关节（TMJ）超声（US）与临床评估和临床综合指数相比在评估 TMJ 受累方面的准确性。
我们对 2018 年至 2021 年间至少接受过一次 TMJ US 检查和颌面外科医生评估的被诊断为 PsA 的患者进行了前瞻性队列研究。风湿病医师对每一次 TMJ US 检查（存在/不存在 TMD）的解释与银屑病关节炎疾病活动指数和颌面外科医生的临床判断（存在/不存在 TMD 体征和/或症状）进行了比较。
共纳入 142 例银屑病关节炎患者。111 例患者完全无症状，但 58.5%的患者已经出现 TMJ US 改变；此外，103 例患者通过了颌面外科医生的检查，但没有任何相关发现，但在这些患者中，55.3%已经出现 TMJ US 下 TMD 的征象。对有和无 TMJ 滑膜炎以及有和无活跃功率多普勒信号的亚组进行单变量分析显示，患有 TMD 的患者外周附着点受累的患病率显著更高（95.7% vs. 4.3%，p=0.001；72.2% vs. 27.3%，p=0.007）。多变量回归分析证实了这些结果（p=0.01 和 p=0.013）。
外周附着点受累可能是 PsA 患者 TMJ 滑膜炎发展的潜在危险因素。由于 TMD 通常无症状发生，TMJ US 可能会检测到 TMD 的早期征象，从而确保及早和充分的管理。
