Erosive temporomandibular joint involvement: a rare manifestation of arthropathies associated with ulcerative colitis.

To the Editor: Temporomandibular joint (TMJ) involvement in patients with enteropathic arthropathy is an unusual feature. To the best of our knowledge, there is only one report in the literature mentioning a patient in whom ankylosing spondylitis (AS) and ulcerative colitis (UC) were seen concurrently with involvement of TMJ. In this case, TMJ disease was assumed as a feature of the patient's spondylitis. (1) We report a case of unilateral erosive TMJ arthritis in a patient with a 13 year history of UC. She was complaining of pain on her right temporomandibular joint beginning three months earlier. Her mouth opening was only 18 mm. Erythrocyte sedimentation rate and C-reactive protein were normal, and rheumatoid factor was negative. Clinical and radiological evaluation revealed no finding attributable to spondylitis, sacroiliitis or rheumatoid arthritis (RA). Conventional x-rays did not show structural abnormality of the temporomandibular joints as in the x-rays of the patient reported by Eyanson et al. (1) However, axial computed tomography (CT) revealed erosion and subchondral sclerosis of the right mandibular condyle. We have concluded that reactive sclerosis accompanying erosion in the right mandibular condyle of this patient is a feature of arthritis which commonly occurs in seronegative spondyloarthropathies, such as enteropathic arthropathy rather than degenerative joint disease. TMJ involvement may be seen in patients with various rheumatic diseases. According to Helenius et al, (2) TMJ erosion was more common in patients with SpA than other rheumatic diseases. Thus, two other confounding diagnoses for our patient would have been RA or AS accompanying UC. However, clinical and radiological evaluation revealed no finding attributable to these diseases. Our patient was followed throughout a nine month period and development of arthritis in the wrist or hand was not seen.

The patient was HLA-B35 positive, a finding suggestive of type I peripheral arthritis of inflammatory bowel disease (IBD). Type 1 peripheral arthropathy seen in patients with IBD is a pauciarticular, self-limiting oligoarticular form. Peripheral arthritis related to IBD may resolve spontaneously. (3,4) Our patient was successfully treated with triamcinolone acetonide injection to the right temporomandibular joint, and the mouth opening reached 35 mm nine months after injection.

Taciser Kaya, MD

Altinay Goksel Karatepe, MD

Rezzan Gunaydin, AP

Nesrin Sen, MD

Department of Physical Therapy and Rehabilitation

Izmir Training and Research Hospital

Izmir, Turkey

Fazil Gelal, AP

Department of Radiology

Ataturk Training and Research Hospital

Izmir, Turkey

References

1. Eyanson S, Hutton CE, Brandt KD. Erosive temporomandibular joint disease as a feature of the spondyloarthropathy of ulcerative colitis. Oral Surg Oral Med Oral Pathol 1982;53:136-140.

2. Helenius LM, Hallikainen D Helenius I et al. Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:455-463.

3. Palm Moum B, Jahnsen J, et al. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study). Rheumatology (Oxford) 2001;40:1256-1261.

4. Gravallese EM, Kantrowitz FG. Arthritic manifestations of inflammatory bowel disease. Am J Gastroenterol 1988;83:703-709.

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