血清阴性脊柱关节炎中的颞下颌关节紊乱:风湿病学家需要了解什么?
Temporomandibular joint disorders in seronegative spondyloarthritis: what a rheumatologist needs to know?
作者信息
Syrmou Vasiliki, Grammatikopoulou Maria G, Bogdanos Dimitrios P, Mitsimponas Konstantinos T
机构信息
Department of Rheumatology and Clinical Immunology, Medical School, Faculty of Health Sciences, University of Thessaly, Larissa, Greece.
Department of Oral and Maxillofacial Surgery, James Cook University Hospital, Middlesbrough, United Kingdom.
出版信息
Reumatologia. 2023;61(5):375-388. doi: 10.5114/reum/173078. Epub 2023 Oct 31.
Temporomandibular joint (TMJ) can be affected in the context of spondyloarthritis (SpA) with detrimental impact on individuals' quality of life. Intra-articular inflammation, synovitis, enthesitis, disc displacement and cervical vertebrae malalignment are some of the pathophysiological phenomena involved. Temporomandibular joint disorders (TMD) incidence appears to be higher in patients with ankylosing spondylitis and psoriatic arthritis, especially when clinical evaluation includes not only imaging but relevant history, TMJ examination and diagnostic criteria for TMD. The Visual Analogue Scale (VAS) pain score and Health Assessment Questionnaire Disability Index (HAQ) quality of life score could be useful tools. Panoramic radiographs and ultrasound can be used for screening but in symptomatic patients magnetic resonance imaging (MRI) is preferable. Conservative management and early pharmacological treatment can prevent permanent joint impairment. For refractory cases, early referral to Legislation for Oral and Maxillofacial Surgery (OMFS) specialists is indicated. The aim of this narrative review is to address the involvement of TMJ in SpA and to encourage clinicians to incorporate TMJ assessment in their physical examination and basic screening.
颞下颌关节(TMJ)在脊柱关节炎(SpA)的情况下可能会受到影响,对个体的生活质量产生不利影响。关节内炎症、滑膜炎、附着点炎、盘状移位和颈椎排列不齐是其中一些涉及的病理生理现象。颞下颌关节紊乱(TMD)的发病率在强直性脊柱炎和银屑病关节炎患者中似乎更高,尤其是当临床评估不仅包括影像学检查,还包括相关病史、颞下颌关节检查和TMD的诊断标准时。视觉模拟量表(VAS)疼痛评分和健康评估问卷残疾指数(HAQ)生活质量评分可能是有用的工具。全景X线片和超声可用于筛查,但对于有症状的患者,磁共振成像(MRI)更可取。保守治疗和早期药物治疗可以预防永久性关节损伤。对于难治性病例,建议早期转诊至口腔颌面外科(OMFS)专家处。本叙述性综述的目的是探讨颞下颌关节在SpA中的受累情况,并鼓励临床医生在体格检查和基本筛查中纳入颞下颌关节评估。
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