FOCUS ON TMJ PSORIASIC ARTHRITIS : MULTIDISCIPLINARY APPROACH

Psoriatic arthritis (PA) is a spondyloarthropathy, with spinal and peripheral joint involvement. It’s an inflammatory condition that less commonly but certainly can occur in the TMJ. In literature there’s still a lack of data on prevalence of temporo-mandibular disorders (TMD) in PA patients. A diagnosis of PA of the TMJ is not always easy but, aimed with what suggested by Kononen et. al., authors investigated subjective, clinical, radiographic and sierologic features of temporomandibular disorders in PA patients and reported that involvement of the TMJ may be common. Material and Methods: In this preliminary study, involving patients affected of PA the prevalence rate of anamnestic dysfunction and of clinical dysfunction are shown. The inflammatory condition of this disease may be the major contributing factor to TMD symptoms and signs. The most frequent clinical finding in the patients with TMJ-PA is severe pain. Less evidence of restricted mouth opening and crepitation. TMD signs such as TMJ and muscle tenderness on palpation, morning stiffness/tiredness and TMJ sounds seem to be more frequent in PA patients than in healthy ones. TMD signs and symptoms were found more frequent and more severe in patients with PA than in healthy subjects, mainly caused by the related joint involvement that directly affects the masticatory system. Clinical and radiologic findings are to proper classify and involve the study group with PA to a treatment with arthrocentesis, with an adjuvant diagnosis purpose and therapeutic effect. It was used as an option to treat temporomandibular disorder patients, with the advantage of avoiding TMJ structural alterations that might be found involving other surgical procedures. Its use has positive effect on treatment of both joints, in those patients who showed only radiologic joint degeneration. Results: No clinical-radiological signs or symptoms of progression of articular disease were observed within a period of 12 months after arthrocentesis. Furthermore, there was functional stability of the temporomandibular joint, total absence of local pain and improvement of mouth opening. Conclusion: This study suggests that arthrocentesis can be considered a valid option for the management of TMD with low surgical morbidity and favorable clinical outcomes. Further studies are need to confirm preliminary results.