Prevalence of Temporomandibular Joint Dysfunction in Patients With Ankylosing Spondylitis
Condition: Ankylosing Spondylitis
MeSH terms: Spondylitis; Spondylarthritis; Spondylitis, Ankylosing; Joint Diseases; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Observational

Summary: 
      This study included 113 patients diagnosed with ankylosing spondylitis and 110 healthy
      volunteers. Participants in both groups were evaluated using the 'Diagnostic Criteria for
      Temporomandibular Disorders (DC/TMD)' diagnostic criteria. In addition, the relationship
      between temporomandibular joint dysfunction and disease activity was investigated in patients
      with ankylosing spondylitis.
    

Detailed description: 
      Ankylosing spondylitis (AS) is a chronic, inflammatory disease with an unknown etiology that
      primarily affects the axial spine, especially the sacroiliac joints, and can also involve
      peripheral joints and extra-articular clinical manifestations. Complaints related to
      temporomandibular joint pathologies are commonly observed in the general population but more
      frequent in the group of patients diagnosed with ankylosing spondylitis compared to the
      average population. Although the mechanism of temporomandibular joint involvement in
      ankylosing spondylitis is not fully understood, destruction of the joint capsule or disk,
      synovitis in the joint, and craniovertebral postural changes have been suggested as possible
      mechanisms. In addition, pain due to temporomandibular joint dysfunction can significantly
      affect daily life activities, quality of life, social participation, and the emotional status
      of the individual. Determining the level of relationship between quality of life and
      psychological status will support the development of new interventions and treatment
      approaches to improve patient's quality of life further.

      The age, gender, body mass index, marital status, duration of ankylosing spondylitis (AS)
      diagnosis, symptom onset, treatment for AS, occupation, smoking status, and Human Leukocyte
      Antigen (HLA)-B27 positivity status were recorded for the patient. The 'Diagnostic Criteria
      for Temporomandibular Disorders (DC/TMD),' published in 2014 and translated into Turkish in
      2016, was used to assess the presence of temporomandibular joint dysfunction in the patients.
      This evaluation system consists of two parts: the clinical evaluation and examination
      findings of the current pathology on Axis I, and the psychosocial status of the disease on
      Axis II. The questions in the Symptom Questionnaire on the first axis were directed to the
      patient, and then the results were recorded by performing the examinations indicated on the
      examination form. The diagnosis was determined according to the Diagnostic Criteria for
      Temporomandibular Disorders (DC/TMD) decision tree, and marked on the examination form. Two
      groups were created based on the decision tree: pain and joint disorders. Pain disorders were
      further subdivided into muscle pain, joint pain, and TMD-related headaches; muscle pain was
      further subdivided into local muscle pain, muscle-fascial pain, and referred muscle-fascial
      pain subgroups. Joint disorders were classified as disc displacement with reduction, disc
      displacement with reduction-intermittent locking, disc displacement without reduction-limited
      mouth opening, disc displacement without reduction-limited mouth opening, degenerative joint
      disease, and dislocation.

      On Axis II, the patients were asked to mark the areas where they felt pain on the pain
      drawing form. The marked area was divided into categories according to its size. The level of
      experienced pain was evaluated with the Graded Chronic Pain Scale (GCPS), jaw function
      limitations were assessed with the Jaw Functional Limitation Scale-20 (JFLS-20), depression
      was evaluated with the Patient Health Questionnaire-9 (PHQ-9), anxiety was assessed with the
      General Anxiety Disorder 7 (GAD-7), physical symptoms were evaluated with the Patient Health
      Questionnaire-15 (PHQ-15), and parafunctional activities were evaluated with the Oral
      Behavior Checklist (OBC). Additionally, the relationship between the identified diagnosis and
      psychosocial factors, disease activity, and other disease-specific factors was investigated.
    

Intervention name(s): Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I and II
Intervention type(s): Diagnostic Test
Intervention description(s): The presence of temporomandibular joint dysfunction was evaluated using the diagnostic criteria for temporomandibular disorders (DC/TMD).
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        113 patients with ankylosing spondylitis were diagnosed and 110 healthy volunteers.
      
Keywords: Ankylosing Spondylitis; Temporomandibular Joint Disorders; Temporomandibular Disorders; TMJ; Spondyloarthropathy