Temporomandibular joint arthritis in rheumatic diseases patients: which are the effective rehabilitative approaches for pain relief? A systematic review

BackgroundTemporomandibular disorders (TMD) are a set of musculoskeletal conditions involving the temporomandibular joint, masticatory muscles, and/or associated structures, characterized by symptoms as pain, joint stiffness with limited mouth opening, and joint sounds as crepitus. Rheumatic diseases (RD) are a heterogeneous group of conditions affecting the musculoskeletal system, including temporomandibular joint (TMJ). To date, there is a lack of systematic reviews that properly investigated the efficacy of conservative approaches in reducing pain in rheumatic patients affected by TMJ arthritis. Therefore, this systematic review aimed to evaluate the effectiveness of rehabilitative approaches in pain relief in rheumatic patients with TMJ arthritis.MethodsPubMed, Scopus, and Web of Science were searched from inception until February 25th, 2024, to identify studies including patients with diagnosis of rheumatic disease affecting the temporomandibular joint who underwent specific rehabilitative approaches to reduce pain intensity. The risk of bias of studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.ResultsOut of 479 search results, 115 duplicates were removed, and 364 studies were considered as eligible for inclusion and screened for title and abstract. Out of these, we included 19 papers for full-text screening. Then, 5 papers were included in the synthesis by this systematic review. Four studies assessed patients affected by rheumatoid arthritis, one systemic sclerodermia, and one included patients affected by ankylosing spondylitis, psoriatic arthritis, Sjogren's syndrome, fibromyalgia, common variable immunodeficiency, and chronic polyarthritis. In the included studies, the interventions consisted of intraarticular TMJ injection of corticosteroids performed with or without anesthetics, or irrigation in three studies, dextrose subcutaneous TMJ perineural injection, and lower-level laser therapy (LLLT).ConclusionsThis systematic review showed that rehabilitative approaches (e.g., intra-articular injections and LLLT) might be effective in terms of pain relief in TMD RD-related. However, the heterogeneity of the rehabilitative approaches performed, and the low quality of the included studies do not allow to draw certain conclusions regarding the efficacy of these approaches. Further high-quality studies are mandatory to improve the robustness of the efficacy of the different rehabilitative techniques for pain relief in TMD patients affected by rheumatic diseases.