Temporomandibular joint (TMJ) disfunction and Rheumatoid Arthritis

The temporomandibular joint connects the lower jaw (mandible) to the bone at the side of your head (temporal bone).  To feel the joint, place your fingers just in front of your ears and open your mouth.  The TMJ is a strong, flexible joint that allows us to move our jaw up and down and side to side.  It enables us to talk, eat and yawn.

The temporomandibular joint is a very complicated joint.  It uses a combination of hinge and sliding motions to achieve jaw mobility.  Because of this complexity, problems with the TMJ are a significant challenge to patients and health care providers.  Not to mention the source of a great deal of pain that is hard to treat.

People with forms of inflammatory arthritis, including Rheumatoid Arthritis are prone to problems with their temporomandibular joint.  It commonly develops as a secondary, co-existing condition.

Symptoms of TMJ disorders

The most common symptom is pain in the muscles used when chewing, and in the jaw joint itself.  Other symptoms include:

• Earache and/or headache – referred pain from the jaw.
• Jaw muscle stiffness
• Limited motion and/or locking of the jaw
• Painful clicking, popping or grating in the jaw joint when opening or closing the mouth

The pain will commonly come and go of its own accord.  People with rheumatoid arthritis will often find that their jaw will flare up periodically, just as their other joints do.  Some people experience low level constant pain, that flares up to severe pain, and then dissipates.

Doesn’t sound too bad?  In practice it can be excruciating.  I have lived on baby food and soup for weeks on end, because my jaw is flaring.  TMJ takes all the fun out of eating!  It’s just another choice that RA takes away from you.  A choice as basic as what food you would like to eat today.

Treatments for TMJ disorders

Conservative treatment is usually recommended.   Surgery is a last resort, and doesn’t have a great success rate.  Most treatment is self-care including:

• Eating soft foods
• Applying ice or heat packs to the jaw
• Avoiding large jaw movements – wide yawning,  chewing solid food, etc
• Performing gentle jaw stretching and relaxation techniques
• NSAIDs (Non-steriodal anti-inflammatory drugs)

This gives the jaw time to recover, and hopefully the condition will improve of its own accord.

If not,  cortisone can be injected into the joint.  This is an invasive treatment and can be very painful of its own accord.  It may provide complete relief or it may not work at all.

The TMJ is a very small joint, and injecting steroid into it requires considerable skill.  If the pain is severe and ongoing, it is worth trying, however.

I had a cortisone shot in my jaw.  It gave me about a week’s relief.  Then the pain returned, but not as bad as before.  The procedure itself was painful though, so I probably won’t do it again.  Its just something I will have to learn to live with.

Surgery is also an option, but it is irreversible and can sometimes result in more pain and disability so it should be avoided.  Much more research on TMJ disorders is required, and until more effective treatments are developed, it is a matter of ‘living with it’.  For the vast majority, the pain will resolve on its own, or wax and wane.