A systematic review on masticatory muscle activity of temporomandibular joint in patients with rheumatoid arthritis
DOI:
https://doi.org/10.2340/aos.v84.44959Keywords:
masticatory muscles, quality of life, rheumatoid arthritis, systematic review, temporomandibular jointAbstract
Rheumatoid arthritis (RA) is a systemic autoimmune disorder characterized by chronic inflammation, primarily targeting joints. When it affects the temporomandibular joint (TMJ), it can significantly diminish the quality of life for individuals. Despite the increasing recognition of disorders involving TMJ and the importance of the stomatognathic system, there is a limited number of studies on masticatory muscle activity of TMJ in patients with RA and the changes in the function of these keychewing muscles. The objective of this study was to conduct a comprehensive systematic review of existing evidence concerning the functioning of major chewing muscles in patients with RA, specifically focusing on parameters such as chewing force. Findings from existing research indicate that RA patients exhibit higher prevalence of bone changes in the TMJ, including erosion, flattening, sclerosis, and osteophytes. These alterations are typically diagnosed through cone-beam computed tomography (CBCT). Results demonstrate that individuals with RA are more likely to experience bone changes in TMJ structures compared to those without RA. By synthesizing available data, this review aims to provide insights that can inform clinical management strategies and potentially improve outcomes for patients grappling with RA-related TMJ involvement. This article aims to review TMJ disorder in RA patients.
Downloads
References
Celiker R, Gökçe-Kutsal Y, Eryilmaz M. Temporomandibular joint involvement in rheumatoid arthritis. Relationship with disease activity. Scand J Rheumatol. 1995;24(1):22–5. https://doi.org/10.3109/03009749509095149 DOI: https://doi.org/10.3109/03009749509095149
Maini K, Dua A. Temporomandibular syndrome [Internet]. Treasure Island, FL: StatPearls Publishing; 2024 [cited 2025 April 21]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551612/
Gazali M, Hermiyanty, Faisal. The treatment of temporomandibular joint dislocation during Covid-19 pandemic: result for 8 patients in central Sulawesi Tertiary Care Center. J Int Dent Med Res. 2022;15(3):2398–304.
Storey GO, Comer M, Scott DL. Chronic arthritis before 1876: early British cases suggesting rheumatoid arthritis. Ann Rheum Dis. 1994;53(9):557–60. https://doi.org/10.1136/ard.53.9.557 DOI: https://doi.org/10.1136/ard.53.9.557
Ropes MW, Bennett GA, Cobb S, Jacox R, Jessar RA. 1958 revision of diagnostic criteria for rheumatoid arthritis. Arthritis Rheum 1959; 2:16–20. https://doi.org/10.1002/1529-0131(195902)2:1%3C16::AID-ART1780020104%3E3.0.CO;2-9 DOI: https://doi.org/10.1002/1529-0131(195902)2:1<16::AID-ART1780020104>3.0.CO;2-9
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 re-vised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31: 315–24. https://doi.org/10.1002/art.1780310302 DOI: https://doi.org/10.1002/art.1780310302
Jang S, Kwon EJ, Lee JJ. Rheumatoid arthritis: pathogenic roles of diverse immune cells. Int J Mol Sci. 2022;23(2):905. https://doi.org/10.3390/ijms23020905 DOI: https://doi.org/10.3390/ijms23020905
Witulski S, Vogl TJ, Rehart S, Ottl P. Evaluation of the TMJ by means of clinical TMD examination and MRI diagnostics in pa-tients with rheumatoid arthritis. Biomed Res Int. 2014;2014:328560. https://doi.org/10.1155/2014/328560 DOI: https://doi.org/10.1155/2014/328560
Kourilovitch M, Galarza-Maldonado C, Ortiz-Prado E. Diagnosis and classification of rheumatoid arthritis. J Autoimmun. 2014;48–49:26–30. https://doi.org/10.1016/j.jaut.2014.01.027 DOI: https://doi.org/10.1016/j.jaut.2014.01.027
Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 2002;4(Suppl 3):S265–72. https://doi.org/10.1186/ar578 DOI: https://doi.org/10.1186/ar578
Kearsley-Fleet L, Heaf E, Davies R, Baildam E, Beresford MW, Foster HE, et al. Frequency of biologic switching and the out-comes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatol. 2020;2(4):e217–e226. https://doi.org/10.1016/S2665-9913(20)30025-4 DOI: https://doi.org/10.1016/S2665-9913(20)30025-4
Cordeiro PC, Guimaraes JP, de Souza VA, Dias IM, Silva JN, Devito KL, et al. Temporomandibular joint involvement in rheuma-toid arthritis patients: association between clinical and tomographic data. Acta Odontol Latinoam. 2016;29(3):123–9.
Ogus H. Rheumatoid arthritis of the temporomandibular joint. Br J Oral Surg. 1975;12(3):275–84. https://doi.org/10.1016/0007-117X(75)90058-X DOI: https://doi.org/10.1016/0007-117X(75)90058-X
Akkoc N, Akar S. Epidemiology of rheumatoid arthritis in Turkey. Clin Rheumatol. 2006;25:560–1. https://doi.org/10.1007/s10067-005-0092-2 DOI: https://doi.org/10.1007/s10067-005-0092-2
Goupille P, Fouquet B, Goga D, Cotty P, Valat JP. The temporomandibular joint in rheumatoid arthritis: correlations between clinical and tomographic features. J Dent 1993;21(3):141–6. https://doi.org/10.1016/0300-5712(93)90023-J DOI: https://doi.org/10.1016/0300-5712(93)90023-J
Helenius LM, Tervahartiala P, Helenius I, Al-Sukhun J, Kivisaari L, Suuronen R, et al. Clinical, radiographic and MRI findings of the temporomandibular joint in patients with different rheumatic diseases. Int J Oral Maxillofac Surg. 2006;35(11):983–9. https://doi.org/10.1016/j.ijom.2006.08.001 DOI: https://doi.org/10.1016/j.ijom.2006.08.001
Larheim TA, Smith HJ, Aspestrand F. Rheumatic disease of the temporomandibular joint: MR imaging and tomographic mani-festations. Radiology. 1990;175(2):527–31. https://doi.org/10.1148/radiology.175.2.2326477 DOI: https://doi.org/10.1148/radiology.175.2.2326477
Lin YC, Hsu ML, Yang JS, Liang TH, Chou SL, Lin HY. Temporomandibular joint disorders in patients with rheumatoid arthri-tis. J Chin Med Assoc. 2007;70(12):527–34. https://doi.org/10.1016/S1726-4901(08)70055-8 DOI: https://doi.org/10.1016/S1726-4901(08)70055-8
MacGregor AJ, Snieder H, Rigby AS, Koskenvuo M, Kaprio J, Aho K, et al. Characterizing the quantitative genetic contribution to rheumatoid arthritis using data from twins. Arthritis Rheum. 2000;43(1):30–7. https://doi.org/10.1002/1529-0131(200001)43:1%3C30::AID-ANR5%3E3.0.CO;2-B DOI: https://doi.org/10.1002/1529-0131(200001)43:1<30::AID-ANR5>3.0.CO;2-B
Carlens C, Hergens MP, Grunewald J, Ekbom A, Eklund A, Höglund CO, et al. Smoking, use of moist snuff, and risk of chronic inflammatory diseases. Am J Respir Crit Care Med. 2010;181(11):1217–22. https://doi.org/10.1164/rccm.200909-1338OC DOI: https://doi.org/10.1164/rccm.200909-1338OC
Murphy D, Bellis K, Hutchinson D. Occupational dust and cigarette smoke exposure might link rheumatoid arthritis to COPD. Lancet Respir Med. 2018;6(8):e36. https://doi.org/10.1016/S2213-2600(18)30188-7 DOI: https://doi.org/10.1016/S2213-2600(18)30188-7
Liao KP, Alfredsson L, Karlson EW. Environmental influences on risk for rheumatoid arthritis. Curr Opin Rheumatol. 2009;21(3):279–83. https://doi.org/10.1097/BOR.0b013e32832a2e16 DOI: https://doi.org/10.1097/BOR.0b013e32832a2e16
Soo J, Eldeiry D, Katz S. Prevalence of rheumatoid arthritis in Edmonton and Northern Alberta. Clin Rheumatol. 2021;40(4):1245–48. https://doi.org/10.1007/s10067-020-05352-5 DOI: https://doi.org/10.1007/s10067-020-05352-5
Ahola K, Saarinen A, Kuuliala A, Leirisalo-Repo M, Murtomaa H, Meurman JH. Impact of rheumatic diseases on oral health and quality of life. Oral Dis. 2015;21(3):342–8. https://doi.org/10.1111/odi.12285 DOI: https://doi.org/10.1111/odi.12285
Ettala-Ylitalo UM, Syrjänen S, Halonen P. Functional disturbances of the masticatory system related to temporomandibular joint involvement by rheumatoid arthritis. J Oral Rehabil. 1987;14(5):415–27. https://doi.org/10.1111/j.1365-2842.1987.tb00737.x DOI: https://doi.org/10.1111/j.1365-2842.1987.tb00737.x
Mehra P, Wolford LM, Baran S, Cassano DS. Single-stage comprehensive surgical treatment of the rheumatoid arthritis tem-poromandibular joint patients. J Oral Maxillofac Surg. 2009;67(9):1859–72. https://doi.org/10.1016/j.joms.2009.04.035 DOI: https://doi.org/10.1016/j.joms.2009.04.035
Rivanor RLC, Chaves HV, Val DR, Freitas AR, Lemos JC, Rodrigues JAG, et al. A lectin from the green seaweed Caulerpa Cu-pressoides reduces mechanical hyper‑nociception and inflammation in the rat temporomandibular joint during Zymo-san‑induced arthritis. Int Immunopharmacol. 2014;21:34–43. https://doi.org/10.1016/j.intimp.2014.04.009 DOI: https://doi.org/10.1016/j.intimp.2014.04.009
Schett G, Hayer S, Zwerina J, Redlich K, Smolen JS. Mechanisms of disease: the link between RANKL and arthritic bone dis-ease. Nat Clin Pract Rheumatol. 2005;1:47–54. https://doi.org/10.1038/ncprheum0036 DOI: https://doi.org/10.1038/ncprheum0036
Stabrun AE, Larheim TA, Hoyeraal HM. Temporomandibular joint involvement in juvenile rheumatoid arthritis. Clinical diag-nostic criteria. Scand J Rheumatol. 1989;18:197–204. https://doi.org/10.3109/03009748909099929 DOI: https://doi.org/10.3109/03009748909099929
Olson L, Eckerdal O, Hallonsten AL, Helkimo M, Koch G, Gare BA. Craniomandibular function in juvenile chronic arthritis. A clinical and radiographic study Swed Dent J. 1991;15:71–83.
Kjellberg H, Fasth A, Kiliaridis S, Wenneberg B, Thilander B. Craniofacial structure in children with juvenile chronic arthritis (JCA) compared with healthy children with ideal or postnormal occlusion. Am J Orthod Dentofacial Orthop. 1995;107:67–78. https://doi.org/10.1016/S0889-5406(95)70158-3 DOI: https://doi.org/10.1016/S0889-5406(95)70158-3
Tegelberg A, Kopp S. Clinical findings in the stomatognathic system for individuals with rheumatoid arthritis and osteoar-throsis Acta Odontol Scand. 1987;45:65–75. https://doi.org/10.3109/00016358709098359
Alstergren P, Pigg M, Kopp S. Clinical diagnosis of temporomandibular joint arthritis. J Oral Rehabil. 2018;45(4):269–81. https://doi.org/10.1111/joor.12611 DOI: https://doi.org/10.1111/joor.12611
Uchiyama Y, Murakami S, Furukawa S. Temporomandibular joints in patients with rheumatoid arthritis using magnetic reso-nance imaging. Clin Rheumatol. 2013;32(11):1613–8. https://doi.org/10.1007/s10067-013-2323-2 DOI: https://doi.org/10.1007/s10067-013-2323-2
Tegelberg A, Kopp S. Subjective symptoms from the stomatognathic system in individuals with rheumatoid arthritis and osteoarthrosis. Swed Dent J. 1987;11(1–2):11–22. https://doi.org/10.3109/00016358709098359 DOI: https://doi.org/10.3109/00016358709098359
Ryan D. Painful temporomandibular joint. In: McCarty DJ, Koopman WJ, eds. Arthritis and allied conditions. Philadelphia, PA: Lea & Febiger; 1993, pp. 573–82.
Laskin DM. Diagnosis of pathology of the temporomandibular joint. Clin Imag Perspect. Radiol Clin North Am. 1993;31(1):135–47. https://doi.org/10.1016/S0033-8389(22)02199-6 DOI: https://doi.org/10.1016/S0033-8389(22)02199-6
Helenius LM, Hallikainen D, Helenius I, Meurman JH, Könönen M, Leirisalo-Repo M, et al. Clinical and radiographic findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(4):455–63. https://doi.org/10.1016/j.tripleo.2004.06.079 DOI: https://doi.org/10.1016/j.tripleo.2004.06.079
Barn R, Brandon M, Rafferty D, Sturrock RD, Steultjens M, Turner DE, et al. Kinematic, kinetic and electromyographic re-sponse to customized foot orthoses in patients with tibialis posterior tenosynovitis, pes plano valgus and rheumatoid ar-thritis. Rheumatology (Oxford). 2014;53(1):123–30. https://doi.org/10.1093/rheumatology/ket337 DOI: https://doi.org/10.1093/rheumatology/ket337
Marotte H. The temporomandibular joint and inflammatory rheumatic diseases. Rev Stomatol Chir Maxillofac Chir Orale. 2016;117:223–7.
da Mota LM, Cruz BA, Brenol CV, Pereira IA, Fronza LSR, Bertolo MB, et al. 2011 Consensus of the Brazilian Society of Rheumatology for diagnosis and early assessment of rheumatoid arthritis. Rev Bras Reumatol. 2011;51(3):199–219. https://doi.org/10.1590/S0482-50042011000300002 DOI: https://doi.org/10.1590/S0482-50042011000300002
Londhe P, Guttridge DC. Inflammation induced loss of skeletal muscle. Bone. 2015;80:131–42. https://doi.org/10.1016/j.bone.2015.03.015 DOI: https://doi.org/10.1016/j.bone.2015.03.015
Tartaglia GM, Moreira Rodrigues da Silva MA, Bottini S, Sforza C, Ferrario VF. Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups. Man Ther. 2008;13(5):434–40. https://doi.org/10.1016/j.math.2007.05.011 DOI: https://doi.org/10.1016/j.math.2007.05.011
Raustia AM, Oikarinen KS. Changes in the electric activity of masseter and temporal muscles after mandibular sagittal split osteotomy. Int J Oral Maxillofac Surg. 1994;23(3):180–4. https://doi.org/10.1016/S0901-5027(05)80297-8 DOI: https://doi.org/10.1016/S0901-5027(05)80297-8
Visser A, McCarroll RS, Oosting J, Naeije M. Masticatory electromyographic activity in healthy young adults and myogenous craniomandibular disorder patients. J Oral Rehabil. 1994;21(1):67–76. https://doi.org/10.1111/j.1365-2842.1994.tb01125.x DOI: https://doi.org/10.1111/j.1365-2842.1994.tb01125.x
Liu ZJ, Yamagata K, Kasahara Y, Ito G. Electromyographic examination of jaw muscles in relation to symptoms and occlusion of patients with temporomandibular joint disorders. J Oral Rehabil. 1999;26(1):33–47. https://doi.org/10.1046/j.1365-2842.1999.00356.x DOI: https://doi.org/10.1046/j.1365-2842.1999.00356.x
Bakke M, Holm B, Jensen BL, Michler L, Möller E. Unilateral, isometric bite force in 8-68-year-old women and men related to occlusal factors. Scand J Dent Res. 1990;98(2):149–158. https://doi.org/10.1111/j.1600-0722.1990.tb00954.x DOI: https://doi.org/10.1111/j.1600-0722.1990.tb00954.x
Khabadze ZS, Blokhina AV, Mustafaeva RS, Balashova ME, Abdulkerimova SM, Bakaev Y, et al. Temporomandibular joint in systemic lupus erythematosus: literature review. J Int Dent Med Res. 2019;12(2):727–32.
Hoyuela CPS, Furtado RNV, Chiari A, Natour J. Oro-facial evaluation of women with rheumatoid arthritis. J Oral Rehabil. 2015;42(5):370–7. https://doi.org/10.1111/joor.12255 DOI: https://doi.org/10.1111/joor.12255
Larheim TA, Flöystrand F. Temporomandibular joint abnormalities and bite force in a group of adults with rheumatoid arthri-tis. J Oral Rehabil. 1985;12(6):477–82. https://doi.org/10.1111/j.1365-2842.1985.tb01294.x DOI: https://doi.org/10.1111/j.1365-2842.1985.tb01294.x
Palinkas M, Rodrigues L, Vasconcelos de, Regalo IH, De L, Siessere S, et al. Evaluation of the electromyographic activity of masseter and temporalis muscles of women with rheumatoid arthritis. Hippokratia. 2018;22(1):3–9.
Hiz O, Ediz L, Ozkan Y, Bora A. Clinical and magnetic resonance imaging findings of the temporomandibular joint in patients with rheumatoid arthritis. J Clin Med Res. 2012;4(5):323–31. https://doi.org/10.4021/jocmr1084w DOI: https://doi.org/10.4021/jocmr1084w
Hervert LPC, Viñas DE, García Espinosa LA, Guerrero NP, Gonzales JM, Castanda CIR, et al. Differences in masseter activity in patients with and without self-reported rheumatoid arthritis using surface electromyography: A cross-sectional study. Mouth Teeth. 2017;2(1):1–5. https://doi.org/10.15761/MTJ.1000107 DOI: https://doi.org/10.15761/MTJ.1000107
Rodrigues LAM, Siéssere S, Canto GDL, Taube OLS, Verri ED, Palinkas LG, et al. Effect of rheumatoid arthritis on the masti-catory muscles’ thickness, bite force, mandibular mobility and quality of life of adult women. Int J Oral Dent Health. 2017;3:047. https://doi.org/10.23937/2469-5734/1510047 DOI: https://doi.org/10.23937/2469-5734/1510047
Yilmaz HH, Yildirim D, Ugan Y, Tunc SE, Yesildag A, Orhan H, et al. Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis, Rheumatol Int. 2012;32(5):1171–8. https://doi.org/10.1007/s00296-010-1743-4 DOI: https://doi.org/10.1007/s00296-010-1743-4
Published
Issue
Section
License
Copyright (c) 2025 Kaltrina Kryeziu, Mergime Prekazi Loxha, Besim Hajdari, Leminot Salihu, Mjellma Rexhepi, Rrezarta Alihajdaraj, David Stubljar, Andrej Starc
This work is licensed under a Creative Commons Attribution 4.0 International License.
Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
