title: Deficient cytokine control modulates temporomandibular joint pain in rheumatoid arthritis.
abstract: The aim was to investigate how endogenous cytokine control of tumor necrosis factor (TNF) influences temporomandibular joint (TMJ) pain in relation to the role of anti-citrullinated peptide antibodies (ACPA) in patients with rheumatoid arthritis (RA). Twenty-six consecutive patients with TMJ RA were included. Temporomandibular joint pain intensity was assessed at rest, on maximum mouth opening, on chewing, and on palpation. Mandibular movement capacity and degree of anterior open bite (a clinical sign of structural destruction of TMJ tissues) were also assessed. Systemic inflammatory activity was assessed using the Disease Activity Score in 28 joints (DAS28) for rheumatoid arthritis. Samples of TMJ synovial fluid and blood were obtained and analyzed for TNF, its soluble receptor, soluble TNF receptor II (TNFsRII), and ACPA. A high concentration of TNF in relation to the concentration of TNFsRII in TMJ synovial fluid was associated with TMJ pain on posterior palpation on maximum mouth opening. The ACPA concentration correlated significantly to the TNF concentration, but not to the TNFsRII concentration, indicating that increased inflammatory activity is mainly caused by an insufficient increase in anti-inflammatory mediators. This study indicates that TMJ pain on palpation in patients with RA is related to a deficiency in local cytokine control that contributes to increased inflammatory activity, including sensitization to mechanical stimuli over the TMJ.
authors.affiliation: Department of Dental Medicine, Section for Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Neveen
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: Department of Medicine, Unit of Rheumatology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anca I
authors.initials: AI
authors.lastname: Catrina
authors.affiliation: Department of Oral and Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
authors.forename: Ahmed O
authors.initials: AO
authors.lastname: Alyamani
authors.affiliation: Faculty of Medicine, University of Ummo Alqura, Makkah, Saudi Arabia.
authors.forename: Hamid
authors.initials: H
authors.lastname: Mustafa
authors.affiliation: Department of Dental Medicine, Section for Orofacial Pain and Jaw Function, Karolinska Institutet, Huddinge, Sweden.|Section of Specialized Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.|Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Alstergren
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000276:immunology*; D001323:Autoantibodies / Q000032:analysis / Q000097:blood; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000032:analysis / Q000097:blood; D053583:Interleukin-1beta / Q000032:analysis / Q000097:blood / Q000276:immunology*; D008297:Male; D008409:Mastication / Q000502:physiology; D008875:Middle Aged; D024343:Open Bite / Q000145:classification; D010147:Pain Measurement / Q000379:methods; D010173:Palpation; D010456:Peptides, Cyclic / Q000032:analysis / Q000097:blood; D016059:Range of Motion, Articular / Q000502:physiology; D053573:Receptors, Interleukin-1 Type I / Q000032:analysis / Q000097:blood; D053574:Receptors, Interleukin-1 Type II / Q000032:analysis / Q000097:blood; D047889:Receptors, Tumor Necrosis Factor, Type II / Q000032:analysis / Q000097:blood; D012217:Rheumatoid Factor / Q000032:analysis / Q000097:blood; D013582:Synovial Fluid / Q000737:chemistry; D013705:Temporomandibular Joint Disorders / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000097:blood / Q000276:immunology*
chemical_list: D001323:Autoantibodies; C508590:IL1R1 protein, human; C508592:IL1R2 protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; D010456:Peptides, Cyclic; D053573:Receptors, Interleukin-1 Type I; D053574:Receptors, Interleukin-1 Type II; D047889:Receptors, Tumor Necrosis Factor, Type II; D014409:Tumor Necrosis Factor-alpha; C487763:cyclic citrullinated peptide; D002097:C-Reactive Protein; D012217:Rheumatoid Factor
keywords: pain; rheumatoid arthritis; synovial fluid; temporomandibular joint; tumor necrosis factor