Abstract
A 59-year-old female patient consulted our hospital in May 2011 complaining of right temporomandibular joint (TMJ) pain and malocclusion. Her rheumatoid arthritis (RA) has been medically managed in the Internal Medicine Department since 2007. Oral examination showed a limited mouth-opening of 32 mm, with sole occlusal contact in the right mandibular molars. MRI and CT imaging of TMJ revealed irreducible anterior disc displacement with joint effusion in association with erosive bone changes in the right mandibular condyle. Left TMJ showed reducible disc displacement. Medical management was initiated with MTX application, but recurrence of arthritis including that of TMJ was observed as the dose was reduced to alleviate its side effects. Combined medication with Tacrolimus was not sufficiently effective. In 2011, an appropriate dose of 6 mg/week MTX showed good control of RA after resolving adverse effects, but TMJ symptoms recurred soon thereafter. Splint therapy was started, and molar and premolar occlusal contact was confirmed after five months of treatment. TMJ pain and limited jaw opening were alleviated, and when the occlusal state became favorable after ten months, the splint was removed. MRI follow-up study revealed favorable bone remodeling of the right mandibular condyle.
