Therapeutic potential of perineural injection for temporomandibular joint pain, dysfunction and musculoskeletal ultrasound findings in rheumatoid arthritis patients

Publication date: Available online 30 August 2019Source: The Egyptian RheumatologistAuthor(s): Hanan M. Elshoura, Nayera Z. Saber, Mohamed A. Elwy, Mervat M. AbdelhakimAbstractAim of the workTo assess the effectiveness of perineural injection therapy (PIT) as a new modality in the management of chronic pain and dysfunction of the TMJ in RA patients and to study if it has any role in tissue regeneration.Patients and methodsOut of 19 RA patients with persistent TMJ involvement and pain despite receiving systemic treatment, 13 agreed to have PIT and only 11 completed the study; 21 TMJ (10 bilateral and 1 unilateral) were assessed clinically and by using musculoskeletal ultrasound (MSUS). The disease activity score (DAS28) and modified health assessment questionnaire (MHAQ) were assessed. The visual analogue scale (VAS) for pain was evaluated. The affected TMJs received subcutaneous PIT of 4–6 injections (5% dextrose buffered by 1.7–2 cc of 8.4% sodium bicarbonate solution) with a total of 2–4 cc solution/TMJ.ResultsAll patients were females with mean age of 45.4 ± 9.9 years, disease duration of 9.5 ± 4.1 years; baseline DAS28 was 5.6 ± 1.2 while the median MHAQ was 1.5. There was a significant improvement in VAS for TMJ pain after PIT at rest (from 5 to 3) and at the maximum mouth opening (from 7 to 5) (P 
Source: The Egyptian Rheumatologist - Category: Rheumatology Source Type: research

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ConclusionThe rare clinical entity of a WS necessitates a targeted diagnostic evaluation and therapy. Clinical details, diagnostic studies and treatment are discussed here.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Publication date: Available online 10 November 2019Source: European Journal of RadiologyAuthor(s): Dongfang Liao, Zhibo Xiao, Furong Lv, Jinyun Chen, Lanyu QiuAbstractPurposeTo examine non-contrast enhanced MRI value to evaluate necrotic area and ablation rate of uterine fibroids after high-intensity focused ultrasound (HIFU) thermal ablation.MethodIn total, 508 patients with 598 fibroids who underwent HIFU treatment were enrolled. Contrast-enhanced MRI (CE-MRI) with diffusion-weighted imaging (DWI)were performed before treatment and within two days post-treatment. DWI signal performance of post-operative fibroids was obs...
Source: European Journal of Radiology - Category: Radiology Source Type: research
ABSTRACT A 52-year-old male patient complained of loss of sensitivity and pain in the maxilla. After examination, root canal treatment of tooth 12 was requested. Subsequently, there was a purplish increased volume of softened consistency in the area of vestibular attached gingiva of tooth 12. The anterior upper dental segment presented mobility. Incisional biopsy revealed malignant neoplasm of glandular epithelial origin, suggestive of solid adenoid cystic carcinoma (ACC). An immunohistochemical panel was performed, which confirmed the histopathological suspicion. Solid ACC may lead to diagnostic difficulties, since this l...
Source: Jornal Brasileiro de Patologia e Medicina Laboratorial - Category: Pathology Source Type: research
Publication date: Available online 10 November 2019Source: European Journal of Obstetrics &Gynecology and Reproductive BiologyAuthor(s): Christopher J. Graham, Shona L. Brown, Katy Vincent, Andrew W. Horne
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
ConclusionsMigraine may affect quality of life similarly to early stages of RRMS. Bio-psycho-socio-medical understanding of the two diseases and their impact on patients QoL should be reconsidered.
Source: Neurological Sciences - Category: Neurology Source Type: research
Authors: Crincoli V, Anelli MG, Quercia E, Piancino MG, Di Comite M Abstract Aims: Temporomandibular disorders (TMD) represent a heterogeneous group of inflammatory or degenerative diseases of the stomatognatic system, with algic and/or dysfunctional clinical features involving temporomandibular joint (TMJ) and related masticatory muscles. Rheumatoid Arthritis (RA) is an autoimmune polyarthritis characterized by the chronic inflammation of synovial joints and oral implications such as hyposalivation, difficulty in swallowing and phoning, feeling of burning mouth, increased thirst, loss of taste or unpleasant taste ...
Source: International Journal of Medical Sciences - Category: Biomedical Science Tags: Int J Med Sci Source Type: research
This study establishes animal experimental models that evaluate the chronicity of albumin-induced arthritis hypernociception in the TMJ. Antigen-induced arthritis was generated in rats with methylated bovine serum albumin (mBSA) diluted in complete Freund’s. Intra-articular injection of mBSA (10 µg/TMJ/week) during 3 weeks resulted in a persistent inflammatory hypernociception which was characterized by an inflammatory episode characterized by the increased of lymphocytes, macrophages and pro-inflammatory interleukins IL-12 and IL-18. The persistent model of inflammatory hypernociception induced by arthriti...
Source: Neuroscience - Category: Neuroscience Source Type: research
This study was able to identify that there is an increased risk of 82% (OR 19.9, 95% CI = 0.71-0.89) in developing TMJ dysfunction in patients with RA compared with healthy patients. It is concluded that it is important to perform periodic TMJ exploration to be able to identify early signs and symptoms of dysfunction to avoid progression. This would be reflected in better nutrition and quality of life of the patient.
Source: Revista Espanola de Cirugia Oral y Maxilofacial - Category: ENT & OMF Source Type: research
ConclusionsThese data suggest a causal feed‐forward signalling cascade of these little studied cytokines have the potential to cause recrudescence in this orofacial inflammatory pain model in the absence of TNFα signalling. SignificanceUsing a mouse model of chronic inflammatory temporomandibular joint disorder, we determined that absence of functional TNFR1/R2 induces aberrant inflammatory signalling caused by other increased pro‐inflammatory and decreased anti‐inflammatory cytokines that could serve as blood biomarkers and may predict disease progression.
Source: European Journal of Pain - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
Conclusion: There was a high prevalence of TMD in RA patients, and muscular involvement was the highest among the TMJ involvements. Thus, this study supports TMJ examination should be encouraged in the rheumatology settings.
Source: Nigerian Journal of Clinical Practice - Category: Rural Health Authors: Source Type: research
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