True arthritis (a hot, red, swollen joint) involving the temporomandibular joint (TMJ) is quite rare. It happens in less than 15% of patients suffering from Rheumatoid and Psoriatic arthritis and also in patients with Ankylosing Spondylitis. Osteoarthritis of the TMJ may also occur and is related to loss of the cartilage covering of the joint.

Signs & Symptoms

Inflammatory arthritis of the TMJ usually happens in patients who already have severe arthritis of other joints. Like arthritis elsewhere it tends to cause painful swollen joints with limited movement.
By contrast osteoarthritis tends to cause crunching noises,‘crepitus’, within the joints but may also progress to severe limitation of movement and jaw joint pain.

Complications

In both types of arthritis, complications are progression of the disease causing joint destruction with increasing pain and decreasing movement. Very rarely joint destruction may result in a completely immobile lower jaw ankylosis.

Tests

It is extremely unusual for the temporomandibular joint to be the first joint affected by arthritis and most patients are already diagnosed by the time jaw pain occurs.
Investigation of the jaw joints usually involves MRI scanning to assess joint destruction and with more severe disease exploration of the joint using arthroscopy may be helpful.

Treatment

The initial treatment is the same as for any TMJ pain and includes soft diet, painkillers / anti-inflammatories, physiotherapy and splint therapy.
Injection of steroids into the jaw joint may be helpful.
Patients suffering form Rheumatoid / Psoriatic arthritis are likely to be under the care of a Rheumatologist and treatment for this underlying condition should be carried out in consultation with them.


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