title: Tumor necrosis factor-alpha as a biochemical marker of pain and outcome in temporomandibular joints with internal derangements.
abstract: OBJECTIVE
  Previous studies have demonstrated the presence of tumor necrosis factor-alpha (TNF) in human temporomandibular joint (TMJ) synovial fluid. The present study continues the investigation of the role of TNF in TMJs with internal derangements.
  
  
  METHODS
  Synovial fluid was obtained from 18 TMJs in 12 patients undergoing either arthroscopy (14 joints) or arthrotomy (four joints) for internal derangements. Standardized clinical data were collected preoperatively, intraoperatively, and postoperatively.
  
  
  RESULTS
  When pain on palpation was absent, the mean preoperative TNF level was 14 +/- 6 ng/mL. When pain on palpation was present, the mean TNF level was 42 +/- 39 ng/mL (significant difference at P = .05). When the surgical outcome was poor, the mean preoperative TNF level was 26 +/- 9 ng/mL. When the outcome was within the stated guidelines for a favorable result, the mean TNF level was 12 +/- 7 ng/mL (significant difference at P = .05). In addition, a significant reduction (P = .05) in TNF following joint lavage (preoperative, 48 ng/mL to postoperative, 7 ng/mL) was found.
  
  
  CONCLUSIONS
  The finding of a positive correlation between preoperative pain and TNF values suggests a biochemical basis for the origin of the pain associated with internal derangements. The relationship between preoperative TNF levels and surgical outcome suggests that the prognosis for surgery may be predicted by measuring biochemical markers of joint disease.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Connecticut Health Center, Farmington 06030.
authors.forename: D M
authors.initials: DM
authors.lastname: Shafer
authors.forename: L
authors.initials: L
authors.lastname: Assael
authors.forename: L B
authors.initials: LB
authors.lastname: White
authors.forename: E F
authors.initials: EF
authors.lastname: Rossomando
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D005157:Facial Pain / Q000276:immunology*; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000276:immunology; D010147:Pain Measurement; D011379:Prognosis; D016059:Range of Motion, Articular; D013582:Synovial Fluid / Q000737:chemistry / Q000276:immunology*; D013585:Synovitis / Q000276:immunology*; D013705:Temporomandibular Joint Disorders / Q000276:immunology* / Q000503:physiopathology / Q000601:surgery; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha