Background and objectives: TMJ disorders include noninflammatory osteoarthropathies (internal derangement), primary arthritides (e.g., rheumatoid arthritis). Early recognition of primary arthritis is important in controlling the disease. However, in early disease, joint manifestations are often difficult to distinguish from other forms of inflammatory polyarthritis. Several serological tests and synovial biopsy are proven to support the diagnosis of primary arthritis. The objective of present study is to evaluate the specificity of arthritic serological results in reaching an early diagnosis of primary arthritis when correlated to synovial biopsy outcome.
Methods: A prospective clinical study included 142 patients with unilateral TMJ disorders who underwent primary arthroscopy at Baptist Hospital, Miami, FL in the period from January 2010 to February 2013. Preoperative arthritis blood serology testing was done including: rheumatoid factor (RF), cyclic citrullinated peptide antibody (CCP), HLA B-27 and anti nuclear antibody (ANA). Selected seropositive patients were subjected to synovial tissue biopsy during the primary arthroscopic procedure with a cup biopsy forceps or Temno ® biopsy needle. Statistical analysis was performed using one sample Chi-square test.
Results: The study included 142 unilateral joint patients; 127 (89.4%) females and 15 (10.6%) males, with mean age 42.84 years. 29 joints (20.4%) were seropositive and 113 joints (79.6%) negative which is significantly different P = 0.001. 15 seropositive patients (10.6%) were biopsied. Arthritis positive biopsy (with lymphoplasmacytic infiltrate) was seen in 3 patients (20%), negative in 12 patients (80%) being significantly different P = 0.001. Arthroscopic synovial tissue inflammation was noticed in all seropositive patients, except 2 patients, being positive in all 3 seropositive, positive biopsy patients (100%).
Conclusions: Despite the established role of serology primary arthritis diagnosis, the current study suggests that synovial biopsy and diagnostic arthroscopic findings provide additional and valuable diagnostic tools to isolate TMJ as being involved with primary arthritis.
Key words : TMJ; serology; arthritis; biopsy