When your patients think of rheumatoid arthritis (RA), chances are they think of pain and stiffness in the hands, wrists, and knees. But RA can affect any joint in the body, including the temporomandibular joint (TMJ), which connects the jawbone and skull. We dive into RA and jaw pain: prevalence, symptoms, and tips for your patients to manage their pain.

Prevalence

Estimates of TMJ dysfunction, or temporomandibular disorder (TMD), in RA vary between 2% and 88%. The disparity in clinical findings is thought to be the result of many factors: selection of patient populations, age distribution of patients, duration and severity of RA, disparate criteria and methods for collecting anamnestic data, conflicting definitions of diagnostic criteria, and differing imaging techniques. However, most studies suggest that approximately half of patients with RA develop a clinical involvement of the TMJ.1

Symptoms

Advise your patients to be alert for symptoms of TMJ dysfunction, including2,3:

  • Pain, swelling, and tenderness in one or both temporomandibular joints
  • Limited mobility in the jaw
  • Aching in and around the ear
  • Aching facial pain
  • Difficulty chewing
  • Locking of the joint
  • Clicking sounds emanating from the jaw
  • Grating sensations

Treatment and Lifestyle Changes

Treatment for TMD in RA is similar to treatment for any joint affected by RA. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce pain and inflammation while disease-modifying anti-rheumatic drugs (DMARDs) are used to promote remission and prevent progressive joint destruction.4

In addition, your patients can implement a number of lifestyle changes to help alleviate their symptoms2,5:

  • Eat soft foods
  • Massage their TMJs
  • Apply hot and cold compresses
  • Avoid chewing gum and chewy candies
  • Avoid opening their mouth too wide when eating, talking, and yawning
  • Avoid clenching their jaw
  • Avoid resting their chin on their hand

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A pair of exercises may also help your patients, provided the joint is not inflamed. Instruct them to5:

  1. Slowly open their mouth, curl their tongue so that the tip contacts the roof of their mouth, and slowly close their mouth while keeping their tongue in position.
  2. In front of a mirror, slowly open and close their mouth without swinging the jaw to either side.

Final Note

It’s not certain exactly how many patients with RA experience TMJ dysfunction. Advise your patients to stay alert for common indicators and implement lifestyle changes to keep their symptoms in check.

References

  1. Witulski S, Vogl TJ, Rehart S, Ottl P. Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in patients with rheumatoid arthritis. Biomed Res Int. 2014;2014:328560.
  2. Jaw problems: RA and the jaw. National Rheumatoid Arthritis Society. Accessed July 31, 2019.
  3. TMJ disorders: overview. Mayo Clinic. December 28, 2018. Accessed July 31, 2019.
  4. Sodhi A, Naik S, Pai A, Anuradha A. Rheumatoid arthritis affecting temporomandibular joint. Contemp Clin Dent. 2015;6(1):124-127.
  5. Duckworth H. RA and jaw pain: can rheumatoid arthritis cause jaw pain? Rheumatoid Arthritis Support Network. October 27, 2018. Accessed July 31, 2019.