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IF no sacroiliitis on imaging, HLA-B27+ and 2+ SpA features are requiredДЈ+ points from weighted items of the following IF sacroiliitis on imaging, 1+ SpA feature is required Score of 6+ out of the following, which are weighted:Д¤+ of 11 criteria including mucocutaneous and major organ clinical criteria and immunologic laboratory criteriaДЄdditional clinical or immunologic criteria are weighted and are additive towards a final score (в‰Ґ10 = SLE)ДЈ+ months of back pain with onset prior to 45 years of age Pulmonary arterial hypertension and/or interstitial lung diseaseДЄnti-centromere, -topoisomerase I, or -RNA polymerase III antibodies For example, a cursory review of the literature on TMJ disease in rheumatic diseases reveals many case reports of TMJ ankylosis however, the astute reader must realize the entire reason such reports are worthy of case reports is their overall infrequency amongst a given population.ДЄn abbreviated reference of diagnostic criteria for each condition which can manifest with TMJ dysfunction is presented in Table 1.Д®ach item is weighted with total score в‰Ґ 9 indicative of definite SSc It should also be noted that the more infrequent a specific set of conditions is reported in the literature (e.g., significant TMJ disease in patients with a specific rheumatologic diagnosis), the more anecdotal the reports become. ( a) Bilateral toe involvement requiring Hoffman procedure ( b) Bilateral wrist involvement ( c) CT of the face showed early unilateral right TMJ ankylosis, lateral pannus formation, and heterotopic bone formation. Her history was most notable for long-standing RA refractory to multiple medications. Throughout this manuscript, вЂњrheumatic diseasesвЂќ is used to refer primarily to inflammatory autoimmune conditions, unless otherwise indicated (e.g., osteoarthritis).Д¬omprehensive management of the TMJ in rheumatic diseases is based upon the initial understanding of four important principles:ДЄ 56-year-old female presented for evaluation with chief complaints of right TMJ pain and limited mandibular opening. Joint diseases should collectively be referred to as вЂњarthropathiesвЂќ, although in the English language the term вЂњarthritisвЂќ has been used extensively and in disparate contexts. The terminology used to refer to these musculoskeletal conditions is often inconsistent and confusing. Although certain autoimmune rheumatic diseases are less common, their individual patient morbidity can be significantly more serious. The World Health Organization (WHO) has quantified the worldwide morbidity of some of the most common arthritic conditions, with 25% of those with osteoarthritis (OA) unable to perform major daily activities of living, and 50% of those with rheumatoid arthritis (RA) unable to perform full-time job activities within 10 years of disease onset. One-fifth to one-fourth of Americans report a doctor-diagnosed arthritic condition, with the Centers for Disease Control and Prevention (CDC) confirming that approximately 25% of US adults suffer from arthritis. It is thus crucial that rheumatologists, dentists, oral and maxillofacial surgeons (OMS), and head and neck surgeons are able to independently understand the TMJвЂ™s place in manifesting rheumatic diseases. Furthermore, it should be kept in mind that the young to middle-aged female population is the typical patient population presenting with autoimmune disorders and TMD.

Similarly, patients with known rheumatic diseases should be investigated for TMJ involvement.

When significant intracapsular TMJ damage and dysfunction are present, occlusal imbalance or myofascial pain are never the cause, and an underlying arthropathy must be investigated. Although TMJ disorders (TMD) are often thought of as dental or orofacial phenomena, we must not forget that true intracapsular, diacapitular TMJ disease is an arthropathy. The temporomandibular joint (TMJ) is a synovial joint of high functional significance.

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