Temporomandibular disorders in patients with rheumatoid arthritis: A clinical study

OBJECTIVES

The aim of this study is to evaluate the prevalence and type of temporomandibular disorders (TMD) in patients with rheumatoid arthritis (RA).

MATERIALS AND METHODS

Fifty-four patients having RA treatment at Cukurova University in Rheumatology Clinic were enrolled to the study. Demographic and rheumatologic data were recorded. The patients were examined in Dental Faculty by using Research Diagnostic Criteria/TMD (RDC/TMD) axis I and answered RDC/TMD axis II Biobehavioral Questionnaire. Data were evaluated according instructions for scoring and assessment of RDC/TMD. Mann-Whitney test was performed to compare continuous variables between two groups and Kruskal-Wallis test was performed to compare continuous variables for more than two groups.

RESULTS

Although their activity situations were 55.6% active and 44.4% inactive, the distribution of treatment modality was 31.5% for anti-tumor necrosis factor-α (TNF-α) and 68.5% for disease-modifying antirheumatic drugs (DMARD). The distribution of temporomandibular joint (TMJ) involvement was; 9.3% with no involvement, 7.4% with joint involvement, 64.8% with muscular involvement, 18.5% with both muscular and joint involvement. Rheumatologic functional scores were (0) 3.7%, (1) 50%, (2) 38.9%, (3) 7.4%. Patients' chronic pain was graded from 0 to 4 and the distribution was 3.7%, 24.1%, 20.4%, 31.5% and 20.4%, respectively. The mean duration of RA for anti-TNF-α (11.47 ± 7.67) was significantly higher compared with DMARD (7.09 ± 5.21) P = 0.040.

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.

The association between nutritional status and frailty characteristics among geriatric outpatients

BACKGROUND

Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic.

METHODS

Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNA< 17 indicated malnutrition and MNA 17-23.5 indicated risk of malnutrition. 'More frail' patients (≥3 frailty characteristics) were compared to 'less frail' patients (<3 frailty characteristics) with logistic regression analyses, adjusted for age, sex and other important covariates.

RESULTS

Of 404 patients with complete data, mean age (SD) was 80 (7) years and 34% was male. Prevalence of 'more frail' patients was 47%. Prevalence of malnutrition and risk of malnutrition was 16% and 56% respectively. Malnutrition and risk of malnutrition were both independently related to being 'more frail', with ORs (95% CI) of 8.1 [3.5-18.8] and 3.1 [1.7-5.5] respectively. This association was driven by functional decline (ADL, IADL and mobility) and depression (GDS), but not by cognitive impairment (MMSE). None of the micronutrient plasma concentrations were related to frailty.

CONCLUSION

In geriatric outpatients, malnutrition is independently related to having ≥3 frailty characteristics. Assessing nutritional status could prove usefulness in early clinical detection and prevention of frailty.

Correction of posttraumatic maxillary deficiency by anterolateral alveolar osteotomy

Anterolateral alveolar osteotomy was performed in a patient who experienced facial trauma in a traffic accident. Bony sequela had remained in the maxilla after the emergency surgery, affecting the facial appearance. A different technique of osteotomy for this unusual type of deformity is presented.