Clinical Diagnosis of Temporomandibular Joint Arthritis

Methods: One hundred ninety-six TM joints in 142 patients with diseases that may cause TMJ arthritis (79 rheumatoid arthritis, 16 psoriatic arthritis, 6 osteoarthritis, 13 ankylosing spondylitis, 3 Sjögren’s syndrome, 25 chronic poly- or monoarthritides) as well as 23 TM joints in 14 healthy subjects were included. A clinical examination regarding TMJ pain at rest, on jaw movements and on lateral palpation was performed. TMJ synovial fluid samples according to Alstergren et al. 1999 were obtained and analyzed for true synovial fluid concentrations of inflammatory mediators. Presence of serotonin, TNF or IL-1beta in the TMJ synovial fluid was used as reference standard for arthritis, as previously established. 80% of the TMJs in the patients but no joints in the healthy subjects showed mediator levels indicating arthritis. Single clinical variables and combinations of variables were analyzed for sensitivity and specificity of the diagnose arthritis.

Results: The combination of TMJ pain on mouth opening and on joint palpation showed the highest sensitivity, 0.86, and a specificity of 0.46. Absence of TMJ pain on mouth opening showed the highest specificity, 0.83. 

Conclusion: TMJ pain on mouth opening in combination with TMJ pain on palpation seems to be a clinical finding relevant for diagnosis of TMJ arthritis. Absence of TMJ pain on mouth opening appears to be the best available clinical test to exclude arthritis in the TMJ.