Ultrasound analysis of progress of rheumatoid arthritis in temporomandibular joints and joints of the hands

Abstract

Rheumatoid arthritis (RA) is a chronic progressive degenerative inflammatory autoimmune systemic disease characterized by peripheral polyarthritis. The hands are usually the most affected and studied. Argentine Society of Rheumatology cites: "symmetric joint inflammation of small and large joints such as hands, feet, knees, elbows, shoulders, hips, which may compromise diarthrodial joints such as temporomandibular and cricoarytenoid joints", specifying the temporomandibular joints (TMJ), not studied to a similar way. Objective: To observe the progress of RA in the TMJs and the joints of the hands.

A cross-sectional descriptive observational study was conducted. Approved by CIEIS of Hospital Córdoba. Sixty patients who consecutively attended the Rheumatology Service of the Hospital Córdoba were studied and evaluated jointly by a dentist and a rheumatologist. They met the criteria for RA according to the American College of Rheumatology. The same medical specialist in Diagnostic Imaging performed all the Doppler ultrasounds of the joints: right proximal interphalangeal joint, left proximal interphalangeal joint, right metacarpophalangeal joint, left metacarpophalangeal joint, right carpal joint, left carpal joint, right temporomandibular joint, and left temporomandibular joint. Effusions <2mm and ≥2mm were differentiated. Regular and irregular bone surfaces were recorded.

In right joints, with joint effusion ≥ 2 mm, irregular surfaces appeared: TMJ 50% condylar surfaces, 44% glenoid cavities. In the carpal rac joints. and inc. 44%, metacarpophalangeal 11% and proximal interphalangeal 6%. While the joints on the left side, with irregular bone surfaces and joint effusion ≥ 2mm: TMJ 28% condylar, 33% glenoid cavities. In carpus rac. and inc. 44%, metacarpophalangeal 17% and proximal interphalangeal 6%.

The information provided by the ultrasound of the temporomandibular joints and the hands was convincing in showing the progress of the disease. For this pathology, ultrasound is an innocuous, economical and painless means of diagnosis, with easy access and instrumentation. TMJs are not usually routinely evaluated by the rheumatologist, although they are the most social joints and the patient's diet depends on them. Data from both joints are fundamental in interdisciplinary decision-making and joint action on the progress of RA, improving the patient's prognosis and quality of life.