Interpreting TMJ Pain Beyond Conventional TMD Etiologies
Misdiagnosed TMJ Pain Revealing Systemic Disease
Abstract
Temporomandibular joint (TMJ) pain is frequently encountered in oral medicine and is commonly attributed to primary temporomandibular disorders (TMDs). However, inflammatory arthropathies may involve the TMJ and present with orofacial symptoms, leading to misdiagnosis and delayed referral. Ankylosing spondylitis (AS), a seronegative spondyloarthropathy mainly affecting the axial skeleton, rarely presents with TMJ involvement, especially in young females.A young female presented with chronic TMJ pain accompanied by fatigue and functional limitation. Clinical evaluation suggested inflammatory TMJ arthritis rather than mechanical TMD. She also reported inflammatory low back pain with prolonged morning stiffness and reduced spinal mobility. Laboratory evaluation revealed HLA-B27 positivity, with negative rheumatoid factor and antinuclear antibody results. Imaging supported inflammatory TMJ involvement, leading to a diagnosis of ankylosing spondylitis in collaboration with rheumatology. TMJ pain may be an early manifestation of systemic inflammatory disease, requiring thorough evaluation and multidisciplinary referral for timely diagnosis and management.
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