The Role of Magnetic Resonance Imaging of the Temporomandibular Joint in Patients with Rheumatoid Arthritis

Objective. To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of changes in the temporomandibular joint (TMJ) in patients with rheumatoid arthritis (RA).

Materials and Methods. 79 patients with RA aged 25–63 years were examined at the Clinical Hospital No. 1 (Smolensk) from December 2023 to August 2024: seropositive (n = 43) and seronegative (n = 36). Among them 51 (64.5 %) women, 28 (35.5 %) men. All patients underwent TMJ MRI at the first examination by a dentist and an orthodontist and after complex treatment of the dental system and RA (after 6 months).

Results. Internal TMJ derangements were analyzed according to the Wilkes C. scale. Patients with RA have certain internal derangements, which confirms the relationship of chronic inflammation with the development of changes in the TMJ. All this required joint management of the patient by a rheumatologist and an orthopedic surgeon. It should be noted that bilateral internal TMJ derangements were diagnosed in 31 (72.1 %) patients with seropositive RA and in 11 (30.6 %) with seronegative RA. 6 months after the prescribed orthopedic treatment, according to patients, 33 (41.8 %) people did not follow the recommendations, which was manifested by persistent and more pronounced clinical manifestations of internal TMJ disorders. 46 (58.2 %) of the subjects followed the recommendations, and during the control MR examination of the TMJ, 39 (84.7 %) of them showed stabilization of the process, without deterioration, there was no clinical pain syndrome, which was regarded as a improvement. But in 7 (15.3 %) of 46 patients, the pain syndrome persisted, and in a conversation with patients in this group, they indicated that, unfortunately, the recommended splint was removed overnight, due to the sensation of a foreign body, which led to greater discomfort. So 40 (50.6 %) out of 79 people were in the group of patients who did not follow the doctor's recommendations. In this group of patients, the orthopedic dentist noted the ineffectiveness of the prescribed therapy, according to the rheumatologist, RA remission was not achieved, the dentist's recommendations were not followed.

Conclusion. 1. In patients with clinical manifestations of internal TMJ disorders, MR criteria characteristic of stages 1–4 according to Wilkes C scale were found: significantly more often in patients with seropositive RA.

2. In the absence of complaints from the TMJ, MR characteristic of stages 1 and 2 according to Wilkes scale were found in patients with RA both with seropositive and seronegative variants of RA.
3. TMJ MRI allows to evaluate the effectiveness of therapy in patients with RA on
4. It is necessary to include TMJ MRI in the algorithm of examination of patients as a mandatory diagnostic minimum upon admission and after 6 months of dynamic follow-up period, in order to provide orthopedic care in

1. Dergilev A. P., Ilуin A. A., Adonyeva A. V., Manakova Ya. L., Bekreev V. V. The Algorithm of radial investigation tactics in temporomandibular joint disease. Siberian Medical Journal. 2010;25 (3-2):24-31. (In Russ.).

2. Drobyshev A. Yu., Zaslavsky I. D., Dubinina T. V., Kuznectsov A. N., Shipika D. V. Minimally invasive surgical treatment for temporomandibular joint in patients with various rheumatic diseases. Sovremennaya Revmatologiya = Modern Rheumatology Journal. 2017;11(4):12-17. (In Russ.). http://doi.org/10/14412/1996-7012-2017-4-12-17

3. Kolotova N. N., Ron G. I., Sbitneva N. N., Bejkin Ya. B., Trofimova O. B., Kolotova G. B., Kuevda D. A. Microbiological profile of periodontal pocket’s of patients with rheumatoid arthritis. Journal of Ural Medical Academic Science. 2013;43(1):67- 69. (In Russ.).

4. Komolov I. S., Vasil’ev A. Yu., Smyshlyaev I. A. Magnetic resonance tomography of the temporomandibular joints in assessing of the evaluation between pain syndrome and internal derangements staged by the Wilkes scale. Kremlin medicine. Clinical Bulletin. 2018;3:145-149. (In Russ.). http://doi.org/10/14412/1996-7012-2017-4-12-17

5. Lazarev Yu. V., Nechkin S. B., Antonova I. N., Petrova M. S., Inamova O. V. Patterns of TMJ diseases in patients with rheumatoid arthritis stratified by gender and age. The Dental Institute. 2023;100(3):46-48. (In Russ.).

6. Lezhnev D. A., Petrovskaya V. V. Modern Radiological Trends in Dentistry and Maxillofacial Surgery (Lecture). Radiology – Practice. 2019;5:57-73. (In Russ.).

7. Nasonov E. L., Lila A. M., Karateev D. E., Mazurov V. I., Amirdzhanova V. N., Belov B. S., Gordeev A. V., Galushko E. A., Dubinina T. V., Zhiljaev E. V., Lukina G. V., Murav'ev Ju. V., Pchel'nikova P. I., Chichasova N. V. Revmatoidnyj artrit. Federal'nye Klinicheskie rekomendacii po vedeniju bol'nyh. M., 2024. 120 p. (In Russ.).

8. Oreshaka O. V., Dementieva E. A., Ganisik A. V., Sharov A. M. Epidemiology of temporomandibular joint disorders. Clinical Dentistry (In Russ.). 2019;92(4):97-99. (In Russ.). http://doi.org/10.37988/1811-153X_2019_4_97

9. Persin L. S., Karton E. A., Slabkovskaya A. B. Orthodontics. Modern methods of diagnosis of dental anomalies, dentition and occlusion. М.: GEOTAR-Media, 2021. 160 p. (In Russ.).

10. Poryadin G. V., Zakhvatov A. N., Parshina A. Y. Pathogenetic Relationship of Immunological Disorders in Chronic Generalized Periodontitis and Rheumatoid Arthritis. The Russian Archives of Internal Medicine. 2022;12(3):203-211. (In Russ.). https://doi.org/10.20514/22266704-2022-12-3-203-211203

11. Skorikov V. Yu., Lapina N. V., Skorikova L. A. The treatment of muscular-articular dysfunction of the temporomandibular joint in rheumatoid arthritis. Rossiyskiy stomatologicheskiy zhurnal. 2016;20(4): 205-208. (In Russ.). https://doi.org/10.18821/1728-2802 2016; 20 (4): 205-208

12. Skorikov V. Yu., Lapina N. V., Skorikova L. A., Seferyan K. G. Features of the preparation of the oral cavity of patients with partial absence of teeth, burdened with a dysfunctional syndrome TMJ on the background of rheumatoid arthritis. Rossiyskiy stomatologicheskiy zhurnal. 2016;20(3):141-145. (In Russ.). http://doi.org/10.18821/1728-2802 2016; 20 (3): 141-145

13. Tarasenko S. V., Dydykina I. S., Nikolaeva E. N., Tsarev V. N., Makarevich A.A. The importance of additional methods for examining patients with chronic generalized periodontitis in combination with rheumatoid arthritis. Clinical Dentistry (Russia). 2019;91(3):36-39. (In Russ.). https://doi.org/10.37988/1811- 153X_2019_3_36

14. Crincoli V., Anelli M. G., Quercia E., Piancino M. G., Di Comite M. Temporomandibular Disorders and Oral Features in Early Rheumatoid Arthritis Patients: An Observational Study. Int. J. Med. Sci. 2019;16(2):253-263. https://doi.org/10.7150/ijms.28361

15. Kim J. W., Park J. B., Yim H. W., Lee J., Kwok S. K., Ju J. H., Kim W. U., Park S. H. Rheumatoid arthritis is associated with early tooth loss: results from Korea National Health and nutrition examination survey V to VI. Korean J. Intern. Med. 2019;34(6):1381-91. https://doi.org/10.3904/kjim.2018.093

16. Rodríguez-Lozano B., González-Febles J., Garnier-Rodríguez J. L., Dadlani S., Bus abad-Reyes S., Sanz M., Sánchez-Alonso F., Sánchez-Piedra C., González-Dávila E., Díaz-González F. Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study. Arthritis. Res. Ther. 2019;21(1):27. https://doi.org/10.1186/s13075-019-1808-z

17. Savtekin G., Sehiiril A. O. Rheumatoid arthritis in temporo — mandibular joint: A review. Niger J. Clin. Pract. 2018;21(10): 1243-1246. https://doi.org/10.4103/njcp.njcp_117_18