Pos0950 the burden of temporomandibular disorders among immune-mediated rheumatic diseases of the adult: a systematic review

Background The temporomandibular disorders (TMDs) encompass a heterogenous group of inflammatory and degenerative diseases which impair the masticatory function causing local pain and dysfunctional consequences of the temporomandibular joint (TMJ) [1]. Objectives To systematically review the literature concerning TMDs in immune-mediated rheumatic diseases (IMRDs) of the adult and synthetize their burden in multiple domains of clinical interest: patient-reported outcomes (PROs), frequencies of signs on physical examination, imaging features, histological findings, and risk factors for their development in patients with IMRDs. Methods A literature search on PubMed Central, Embase and Cochrane Library databases was performed, until June 2022, for studies including TMJ outcomes in IMRDs patients compared with healthy controls, other rheumatic diseases or in the assessed IMRDs patients after follow-up and treatment. Among the IMRDs of the adult, original articles investigating TMJ involvement in inflammatory polyarthritides and/or autoimmune connective tissue diseases were considered. The TMJ outcomes used in clinical studies, the prevalence of TMDs in IMRDs and the risk factors for their development were qualitatively synthetized. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Results Of the 3259 screened abstracts, 56 papers were included in the systematic review. All of them were evaluated as of fair quality, at least. Most of the papers (77%) investigated TMDs in rheumatoid arthritis (RA) with a prevalence of signs and symptoms varying from 8% to 70% (Table 1). The risk factors for TMDs development in RA were female sex, younger age, anti-citrulline peptide antibodies (ACPA) positivity, higher disease activity, cervical spine involvement, cardiovascular and neuropsychiatric comorbidities (Figure 1). Ten papers (18 %) evaluated TMDs in spondylarthritides (SpA) reporting a prevalence of symptoms and signs in 12%-80% of patients with higher TMDs prevalence in patients with radiographic spine involvement, skin psoriasis and HLADRB1*01 positivity. Among autoimmune connective tissue diseases (CTDs), systemic sclerosis (SSc) displayed the highest evidence of TMDs PROs and clinical findings (20-93%), followed by systemic lupus erythematosus (SLE) in 18-85%, mixed connective tissue disease (MCTD) in 31-63%, primary Sjögren’s syndrome (pSS) in 24-54% and idiopathic inflammatory myopathies (IIMs) in 4-26%. In SSc and SLE, TMDs were more frequent in patients with higher disease activity and duration, correlating with the extent of skin fibrosis in SSc and with renal involvement in SLE. Conclusion TMDs in IMRDs display a significant relevance in the rheumatological clinical practice even if they are often overlooked. This burden is epidemiologically important in terms of PROs and clinical findings which correlate with disease activity in RA, SpA, SSc and SLE. The early recognition and multidisciplinary management of TMDs is warranted and should be aimed at hindering the TMJ structural damage maximizing the quality of life of patients. Reference [1]Covert et al. Diagnostics 2021 Table 1. Prevalence of TMJ findings across multiple clinical domains in different IMRDs. IMRD Domains of TMJ involvement RA SpA SSc SLE pSS MCTD IIMs Number of studies investigating TMJ involvement 43/56 (77%) 10/56 (18%) 5/56 (9%) 4/56 (7%) 4/56 (7%) 3/56 (5%) 1/56 (2%) Prevalence of TMJ PROs 8-70% 12-80% 20-93% 31-66% 24-54% 31% 17-26% Prevalence of TMJ signs on physical examination (i.e., reduced mouth opening) 30-54% 17-68% 44-71% 41-85% 24-44% 50-63% 4-13% Imaging findings on X-ray of TMJ 50-66% 30-38% NA 22% NA 19% NA Imaging findings on computerized tomography of TMJ 61-76% NA NA NA NA NA NA Imaging findings on magnetic resonance imaging of TMJ 11-95% 6-67% 67-94% NA NA 13-93% NA Histological findings of TMJ Synovitis and degenerative changes NA NA NA NA NA NA Legenda. NA: not assessed. See the text for the other abbreviations. Figure 1. Risk factors for TMJ involvement in RA, SpA, SSc and SLE (created with biorender.com) Acknowledgements: NIL. Disclosure of Interests None Declared.