THE SIGNIFICANCE OF TEMPOROMANDIBULAR DISORDER IN PATIENTS WITH RHEUMATOID ARTHTITIS

Cilj ovog rada je bio utvrditi učestalost temporomandibularnog poremećaja (TMP) u bolesnika s reumatoidnim artritisom (RA) i rezultate korelirati s aktivnošću osnovne bolesti. Ispitanici su bili bolesnici s RA, koji se liječe u reumatološkoj ambulanti bolnice „Thalassotherapia-Opatija“ iz Opatije. Dijagnoza TMP je postavljena u 13/21 bolesnika prema međunarodnim Dijagnostičkim kriterijima u bolesnika koji su istovremeno učinili reumatološki pregled i rutinske laboratorijske analize. Bolne poremećaje u TMZ je imalo 4/13 bolesnika i to dva bolesnika s boli i glavoboljom koja se pripisuje TMP, od kojih je jedan dodatno zadovoljavao kriterije za mialgiju i artralgiju te još dva bolesnika koja su imala artralgiju povezanu s TMP-om. Poremećaje unutar zgloba utvrdili smo u ukupno 9/13 bolesnika i to pomak diska bez redukcije i bez ograničenog otvaranja (9), pomak diska bez redukcije s ograničenim otvaranjem (1), poremećaj diska s redukcijom i povremenim kočenjem (1) te degenerativne promjene (6) s ili bez drugih poremećaja zgloba. Kronična bol i funkcijsko ograničenje čeljusti su statistički značajno pozitivno korelirali s bodovima dodjeljenim depresivnom poremećaju i jutarnjoj zakočenosti, ali ne s anksioznim poremećajem, fizičkim simptomima, VAS-u boli u cijelom tijelu ili oralnim nepovoljnim navikama. Bolesnici su bili liječeni terapijom koja mijenja tijek reumatske bolesti i postignut je cilj liječenja RA po preporukama Hrvatskog i Europskog reumatološkog društva, ali 90% bolesnika je imalo tjeskobni i 80% depresivni poremećaj. Dijagnosticiranje TMP-a multidisciplinarnim pristupom osigurava pravovremeno prepoznavanje uzroka, sprječavanje nastanka ili liječenja napredovanja postojećeg poremećaja s ciljem povećanja kvalitete života bolesnika s RA.The aim was to determine the frequency of temporomandibular disorder (TMD) in patients with rheumatoid arthritis (RA) and to correlate the results with the activity of the underlying disease. The diagnosis of TMD was made in 13/21 patients according to the International Diagnostic Criteria in patients who were rheumatologically examined in hospital "Thalassotherapia-Opatija", Opatija and performed routine laboratory analyzes. Pain disorders in TMJ were present in 4/13 patients. The pain and headache attributed to TMJ were diagnozed in two patients (one of whom additionally met the criteria for myalgia and arthralgia) and two more patients had TMD-related arthralgia. Disorders within the joint were found in a total of 9/13 patients: disc displacement without reduction and without limited opening (9), disc displacement without reduction with limited opening (1), disc disorder with reduction and intermittent locking (1) and degenerative changes (6) with or without other joint disorders. Chronic pain and functional limitation of the jaw statistically significantly positively correlated with points assigned to depressive disorder and morning stiffness, but not to anxiety disorder, physical symptoms, VAS for pain throughout the body, or oral unfavorable habits. Patients used disease-modifying anti-rheumatic drugs and achieved the goal of treating RA according to the recommendations of the Croatian and European Rheumatological Society, but 90% of patients had anxiety and 80% depressive disorder. The diagnosis of TMD as a multidisciplinary approach ensures the timely identification of the causes, prevent the development or progression of the existing disorder in order to increase the quality of life in patients with RA