RESEARCH - TMJ pressure pain threshold is systemically modulated in RA

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J Orofac Pain. 2008 Summer;22(3):231-8.

Temporomandibular joint pressure pain threshold is systemically

modulated in rheumatoid arthritis.

Alstergren P, Fredriksson L, Kopp S.

Karolinska Institutet, Clinical Oral Physiology, Huddinge, Sweden.

AIMS: To investigate the relative importance of systemic and local

inflammatory mediators (serotonin: 5-HT; tumor necrosis factor: TNF;

soluble interleukin-1 receptor II: IL-1sRII) in the modulation of

temporomandibular joint (TMJ) pressure pain threshold in patients with

seropositive or seronegative rheumatoid arthritis (RA) and to

investigate to what extent TMJ pressure pain threshold is related to

other TMJ pain parameters.

METHODS: Sixty patients with seropositive RA for rheumatoid factor and

74 patients with seronegative RA involving the TMJ were investigated

regarding synovial fluid and plasma levels of IL-1sRII, 5-HT, and TNF

as well as erythrocyte sedimentation rate, C-reactive protein,

thrombocyte particle count, and rheumatoid factor in blood. TMJ

resting pain, movement pain, tenderness, and palpebral pain reflex to

digital palpation and TMJ pressure pain threshold were examined.

RESULTS: Statistical analyses indicated that TMJ pressure pain

threshold was only correlated to systemic factors. TMJ movement pain

was in turn mainly correlated to systemic mediators in the

seropositive patients but to local mediators in the seronegative

patients where synovial fluid IL-1sRII was positively correlated to

TMJ pain on mouth opening. Seropositive patients had higher systemic

inflammatory activity but lower TMJ movement pain intensities than

seronegative patients.

CONCLUSION: The results indicate that TMJ pressure pain threshold is

modulated by systemic rather than local inflammatory mediators and

suggest that it is unrelated or only weakly related to other TMJ pain

entities in RA patients. A rheumatoid factor-dependent systemic

modulation, in combination with local factors, seems to account for

TMJ pain in RA patients.

PMID: 18780536

http://www.ncbi.nlm.nih.gov/pubmed/18780536

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