Psoriatic arthritis and temporomandibular joint : how to detect the first articular involvement

Many reports have described the damaging effects of Psoriatic Arthritis (PA) on the temporomandibular joints (TMJs), but no study has clearly reported the TMJ as the first articulation to be involved in PA. Objectives The aim is to underline the importance of the paediatric dentist and orthodontist in the contribution to the early diagnosis of PA, avoiding and preventing the orofacial and systemic complications. Materials and Methods Psoriatic Arthritis is a chronic systemic disease that is difficult to detect. The diagnosis is made mainly on clinical grounds based on the findings of psoriasis and inflammatory arthritis of the joints. This work reports a case of PA that was diagnosed several years after a TMJ onset because no other signs apart from psoriasis were present Ultrasound, MRI and CBCT were used. Results The missed early diagnosis resulted in severe TMJ damage. The TMJ can be the first joint involved in PA. It is often unilateral, with a sudden onset. Symptoms include pain and tenderness of the joint area and the muscles of mastication, morning stiffness, tiredness in the jaws, joint crepitation, occasional painful swelling of the TMJ capsule and painful mandibular movements associated with a progressive decrease in the interincisal opening. In severe cases, ankylosis of the TMJ may occur. Conclusions For a correct, early diagnosis of PA, collaboration between the dentist and rheumatologist it is very important. The dentist should recommend in addition to exercise and local pain treatment, an occlusal splint, to help keep the TMJs working properly, improve function, relieve pain, reduce swelling, and prevent further severe TMJ damage.