RHEUMATOID ARTHRITIS INVOLVING THE TEMPOROMANDIBULAR AND CERVICAL JOINTS: FUNCTIONAL AND RADIOLOGICAL ASSESSMENT
Main Article Content
Keywords
Rheumatoid arthritis, temporomandibular joint, cervical spine, Helkimo Index, radiological assessment
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes progressive synovial inflammation and joint destruction, frequently extending beyond peripheral joints to involve the temporomandibular joint (TMJ) and cervical spine. These sites of involvement can significantly compromise mastication, speech, and cervical mobility. Although recent advances in disease-modifying antirheumatic drugs have improved systemic control, TMJ and cervical manifestations remain under-recognized and inadequately characterized. The present study aimed to determine the prevalence, functional impact, and radiological characteristics of TMJ and cervical involvement in RA and to analyze their correlation with inflammatory activity and disease duration. A cross-sectional observational design was employed, involving 100 adult participants (60 RA patients and 40 age- and sex-matched controls) recruited from a tertiary care hospital. Standardized instruments such as the Helkimo Index for TMJ and the Neck Disability Index (NDI) for cervical function, were applied, complemented by radiological assessment through orthopantomography (OPG), magnetic resonance imaging (MRI), and lateral cervical radiographs. Quantitative results revealed significantly higher dysfunction among RA patients: mean Helkimo Index (8.2 ± 2.6) versus controls (2.1 ± 1.3, p < 0.001), and mean NDI (16.8 ± 5.7) versus controls (4.2 ± 2.3, p < 0.001). Radiological findings demonstrated condylar erosion in 58.3%, joint space narrowing in 61.7%, and atlantoaxial subluxation in 21.7% of RA patients, with all p-values < 0.001. Strong correlations were observed between TMJ dysfunction and cervical disability (r = 0.62), CRP levels (r = 0.58), and disease duration (r = 0.66). The study highlights that TMJ and cervical spine involvement constitute significant and interrelated aspects of RA pathology, reinforcing the need for routine clinical and imaging evaluation of these regions to prevent irreversible functional impairment.
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Aimen Gul
Bahria University Medical and Dental College, Karachi
Ghansham Das
Health Sciences Center Winnipeg, University of Manitoba, Canada
Muhammad Muthar Anees
Liaquat College of Medicine and Dentistry, Karachi
Karshma Kumari
Liaquat University of Medical and Health Sciences, Jamshoro
Syeda Khoula Azmat
Dow University of Health Sciences/Dow International Medical College, Karachi
Amber Ansh
McMaster University Hamilton, Ontario, Canada
Sidra Anwar
Civil Hospital, Karachi