title: Reactive arthritis in relation to internal derangements of the temporomandibular joint: a case control study.
abstract: The aim of this study was to find out if reactive arthritis was involved in the aetiology of chronic closed lock of the temporomandibular joint (TMJ) by looking for bacterial antigens in the synovial membrane of the TMJ, and by studying the antibody serology and carriage of human leucocyte antigen (HLA) B27 in patients with chronic closed lock. Patients with reciprocal clicking and healthy subjects acted as controls. We studied a total of 43 consecutive patients, 15 with chronic closed lock, 13 with reciprocal clicking, and 15 healthy controls with no internal derangements of the TMJ. Venous blood samples were collected from all subjects for measurement of concentrations of HLA tissue antigen and serology against Chlamydia trachomatis, Yersinia enterocolitica, Salmonella spp., Campylobacter jejuni, and Mycoplasma pneumoniae. Samples of synovial tissue from patients with closed lock and reciprocal clicking were obtained during discectomy and divided into two pieces, the first of which was tested by strand displacement amplification for the presence of C trachomatis, and the second of which was analysed for the presence of species-specific bacterial DNA using 16s rRNA pan-polymerase chain reaction (PCR). There were no significant differences between the groups in the incidence of antibodies against M pneumoniae, Salmonella spp. or Y enterocolitica. No patient had antibodies towards C trachomatis or C jejuni. We found no bacterial DNA in the synovial fluid from any patient. The HLA B27 antigen was present in 2/15 subjects in both the closed lock and control groups, and none in the reciprocal clicking group. In conclusion, reactive arthritis does not seem to be the mechanism of internal derangement of the TMJ.
authors.affiliation: Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden. Electronic address: bodil.lund@ki.se.
authors.forename: Bodil
authors.initials: B
authors.lastname: Lund
authors.affiliation: Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Holmlund
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Wretlind
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska University Hospital Huddinge, Sweden.
authors.forename: Shah
authors.initials: S
authors.lastname: Jalal
authors.affiliation: Division of Oral and Maxillofacial Surgery, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden; Division of Oral and Maxillofacial Surgery, Department of Clinical Dentistry, University of Bergen, Norway.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosén
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000032:analysis; D016918:Arthritis, Reactive / Q000235:genetics / Q000382:microbiology*; D016123:Campylobacter jejuni / Q000235:genetics / Q000276:immunology; D016022:Case-Control Studies; D002692:Chlamydia trachomatis / Q000235:genetics / Q000276:immunology; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D015796:HLA-B27 Antigen / Q000032:analysis; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D004204:Joint Dislocations / Q000276:immunology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009177:Mycoplasma pneumoniae / Q000235:genetics / Q000276:immunology; D010147:Pain Measurement / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D012475:Salmonella / Q000235:genetics / Q000276:immunology; D013583:Synovial Membrane / Q000276:immunology; D013705:Temporomandibular Joint Disorders / Q000276:immunology / Q000382:microbiology*; D015008:Yersinia enterocolitica / Q000235:genetics / Q000276:immunology; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D004269:DNA, Bacterial; D015796:HLA-B27 Antigen; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Chlamydia trachomatis; Chronic closed lock; Internal derangement; Reactive arthritis; Reciprocal clicking; Temporomandibular joint