TMJ or Temporomandibular Joint Pain

Tags

Arthritis, disc, displacement, jaw, JCA, JRA, osteoarthritis, psoriatic, rheumatoid arthritis

Key points to remember here are:

1. The first step here is to make sure there is no dental issues causing the TMJ such as the mandible not lining up with maxilla. It is not unusual for this to develop after dental work.

2. MRI often provide the details needed to make proper diagnosis as to what is causing the pain in TMJ.

3. The causes here vary from trauma with damage to the joint structures to various forms of arthritis including:

– Disc displacement
– Meniscal tear
– Juvenile Idiopathic Arthritis (Juvenile rheumatoid arthritis)
– Rheumatoid arthritis
– Psoriatic arthritis
– Traumatic arthropathy
– Gout

4. Treatment obviously depends on the cause. Early treatment of the underlying disease is the key to avoid damage to TMJ.

5. Aggressive and early treatment of Rheumatoid, Psoriatic, and JIA with new biologics treatments such as Enbrel and Humira has resulted in significant decline of TMJ problems in these patients.

6. Oral Surgeons often deal with TMJ when medical therapy is exhausted.

C-reactive Protein

Tags

Arthritis, ESR, infection, inflammation, Rheumatic

Points to remember here are:

1. High CPR concentration should raise the suspicion for possible infection.

2. CRP, unlike ESR, can change rapidly as condition evolves.

3. Although CPR is very sensitive, it is not very specific. Therefore physical examination of patient is very important.

4. Common uses of CRP are: Infections, Polymyalgia Rheumatica, Rheumatoid Arthritis, Temporal Arteritis, malignancy, vasculitis,

5. Combination of ESR and CRP as well as history and physical examination will enhance the sensitivity and specificity of these tests.

6. Ultimately patients should be treated based on history and physical examination. These tests are not always reliable.

7. Obtaining both ESR and CRP from the beginning and following them serially will help you decide on which one to use for monitoring the disease activity.