AB0672 PATIENT CHARACTERISTICS AND DISEASE ACTIVITY, BUT NOT THE CRANIOCERVICAL POSTURE ABNORMALITIES PREDICT TEMPOROMANDIBULAR DISORDERS IN ANKYLOSING SPONDYLITIS PATIENTS: A CROSS-SECTIONAL, OBSERVATIONAL STUDY
Authors: E. Bilgin, E. Bilgin, O. Özdemir, U. Kalyoncu
Journal: Annals of the Rheumatic Diseases (2020)

Background: There are contradictory results in the relevant literature about the relationship between objective determinants of craniocervical posture and temporomandibular disorder (TMD), whereas no study has worked on AS and TMD relationship. Objectives: To evaluate the predictors of TMD in AS patients and its relationship with craniocervical posture, we conducted this study Methods: AS patients aged between 18-50 years and consecutively admitted to our outpatient clinics were recruited. TMD was diagnosed by ‘Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)’ criteria. Spinal mobility was assessed by BASMI; disease activity by ASDAS-CRP and neck disability by Neck Disability Index. We measured the craniocervical angle, cervical curvature angle, suboccipital distance, atlas-axis distance, anterior translation distance by using the lateral cervical X-rays (Figure). Results: A total of 98 (58.2% female) patients with a mean age of 37.4 ±48.2 years was recruited (Table 1). TMD was diagnosed in 58 (59,2%) patients. Spinal mobility and craniocervical posture measurements were similar among the two groups (Table2). Smoking, bruxism (in females), neck disability and AS activity (in males) were higher in TMD patients (Table 1). Multivariate analysis revealed active smoking (aOR 6.86; CI: 1.83-25.60; p=0.004), bruxism in females (aOR 17.87; CI: 2.0-159.20; p=0.01), high ASDAS in males (aOR 11.82; CI: 1.14-122.5; p=0.038) and neck disability (aOR 12.67; CI: 3.75-42.85; p&lt;0.001) as independent risk factors for TMD in AS patients. Table 1. The clinical and demographical data of the study population Parameter All patients TMD (+ ) (n=58 ) TMD (-) (n=40 ) P value Gender (Female) 57 (58.2) 38 (65.5) 19 (47.5) 0.076 Age 37.4±8.2 37.8±7.7 36.9±8.9 0.57 Smoking Smoker 33 (33.7) 25 (43.1) 8 (20.0) 0.017 Non-smoker 65 (66.3) 33 (56.9) 32 (80.0) AS disease duration (year) 8.1±5.7 7.8±6.2 8.6±5.0 0.47 AS treatment NSAID 0.52 Regular 13 (13.2) 8 (13.8) 5 (12.5) On-demand 49 (50.0) 31 (53.4) 18 (45.0) Sulphasalazine 38 (38.7) 24 (41.4) 14 (35.0) 0.67 Anti-TNF agents 59 (60.0) 33 (56.9) 26 (65.0) 0.42 Bruxism Present 61 (62.2) 43 (74.1) 18 (45.0) 0.003 Nighttime 18 (29.5) 11 (25.6) 7 (38.9) Daytime 15 (24.6) 10 (23.3) 5 (27.8) Whole day 28 (45.9) 22 (51.2) 6 (33.3) Absent 37 (37.8) 15 (25.9) 22 (55.0) Table 2. Comparison of AS-related and craniocervical posture measurements Parameter All patients TMD (+ ) (n=58 ) TMD (-) (n=40 ) P value AS-related measurements ASDAS 2.4±0.95 2.7±0.93 2.0±0.85 0.001 Male 2.3±1.3 2.7±1.14 1.7±0.85 0.007 Female 2.5±0.9 2.7±0.82 2.4±0.78 0.11 Tragus-wall distance (cm ) 11.7±2.55 11.6±1.97 12.0±3.24 0.41 Cervical rotation (angle ) 71.6±12.78 71.6±12.32 71.5±13.59 0.94 Chin-thorax distance (cm ) 2.1±1.64 2.1±1.44 2.1±1.91 0.90 BASMI 2.0±1.19 2.0±1.11 2.1±1.31 0.76 mSASSS 3.5±4.84 3.4±3.88 3.8±6.03 0.70 Measurements of craniocervical posture Craniovercival angle 79.6±10.31 78.9±10.47 80.6±10.11 0.41 Cervical curvature angle 165.4±12.42 165.6±12.89 165.0±11.84 0.82 Suboccipital distance (mm ) 6.3±3.97 6.2±4.04 6.5±3.91 0.71 Atlas-axis distance (mm ) 5.2±2.43 5.3±2.47 5.0±2.40 0.62 Anterior translation distance (mm ) 10.9±13.74 11.4±11.79 10.1±16.35 0.66 Conclusion: No relationship between the craniocervical posture measurements and TMD was found in AS patients. Active smoking, high disease activity in males, bruxism in females and neck disability were found as predictors of TMD in AS patients. Figure. For the assessment of cranicervical posture; suboccipital distance (A.a.), atlanto-axial distance (A.b.) anterior translation distance (A.c), craniocervical angle (B.a), cervical curvature angle (B.b) were measured on standardized lateral X-rays. Disclosure of Interests: Esra Bilgin: None declared, Emre Bilgin: None declared, Oya Özdemir: None declared, Umut Kalyoncu Consultant of: Abbvie, Amgen, Janssen, Lilly, Novartis, UCB