Inflammatory and degenerative disease in the temporomandibular joint

Sammanfattning: Temporomandibular joint (TMJ) arthroscopy is an established technique withhigh diagnostic accuracy regarding synovitis and degenerative changes of the articularfibrocartilage and disk. However, so far no studies have been done to correlate themacroscopic and histologic findings with each arthroscopic criterion. Thereforepatients with TMJ internal derangement (ID) were investigated by arthroscopy andarthrotomy (with biopsy) and the findings were compared with observations usinglight microscopy. TMJ specimens obtained at autopsy were used as controls. Onhistological examination, inflammation was present in the majority of the patients butnot in the controls. Arthroscopy revealed inflammation more accurately than didmacroscopic observation at arthrotomy. Reliable arthroscopic criteria for synovitiswere capillary hyperemia and synovial hyperplasia. Both correlated well withhistologic signs of inflammation. Definite clinical and radiographic criteria for rheumatoid arthritis (RA) of theTMJ have been difficult to establish, and no arthroscopic data have been available. Forthis reason, the clinical, radiographic, arthroscopic and histologic examinations inpatients with TMJ ID or RA with TMJ signs and symptoms were compared. In RApatients joint crepitation and hard-tissue changes on the tomograms were morefrequent and arthroscopic and histologic changes were more pronounced than in thosewith ID. Generalized osteoarthritis (GOA) is primarily a noninflammatory disease withinvolvement of three or more joints or groups of joints. This is the first study of theradiographic, clinical, arthroscopic, histologic and immunohistochemical changes insymptomatic TMJs in patients with GOA. The GOA patients were compared with patientshaving RA and TMJ symptoms. An age-matched autopsy material was used as a controlfor histologic and immunohistochemical examinations. On the tomograms, osteophytes,flattening of the condyle or a reduced joint space were observed more often in GOA, buterosions in the condyle were commoner in RA. Compared to RA, the radiographicfindings in GOA seemed more like those in the common form of localized TMJosteoarthritis. The frequency of muscle tenderness was the only clinical sign thatdiffered significantly between GOA and RA (commoner in GOA). On arthroscopy, morepronounced inflammatory and degenerative changes were observed in RA patients,despite a shorter duration of symptoms. A correlation between lateral joint tendernessand pronounced synovitis was noted in RA patients. Histologic and immunohisto-chemical examinations showed equally high frequencies of synovial inflammation inGOA and RA, and differed clearly from those in the controls. The only histologicparameter that differed significantly between patients having GOA and those with RAwas connective tissue degeneration (commoner in GOA). Immunohistochemistry(particularly PCNA = monoclonal mouse anti-proliferating cell nuclear antigen) addeduseful information to the histologic examination. The great similarities between thefindings in GOA and in RA patients indicate that supposedly different etiopathogenesesmay provoke similar tissue reactions in the joint tissues, but pronouncedinflammatory changes and degeneration develop more quickly in RA. Key wordsarthroscopy, clinical findings, degenerative changes, generalized osteoarthritis,histology, immunohistochemistry, internal derangement, radiographic changes,rheumatoid arthritis, synovial inflammation, temporomandibular jointISBN 91-628-1 904-6