Rheumatoid arthritis (RA) is an autoimmune disease with a long duration, in which serious inflammatory symptoms develop slowly. The temporomandibular joint (TMJ) is among the frequently affected joints in late-stage RA, but it is unclear whether or not early-stage RA causes temporomandibular arthralgia. We present an interesting case of arthritis of the TMJ associated with multi-joint pain suggesting very early RA. A 22-year-old female patient was diagnosed with pain of the right TMJ, along with an affected instep and knee joint, showing prominent stiffness in the morning. The range of mouth opening was 40 mm at the first visit. MRI of the left knee joint and ankle showed growth of the synovial membrane and hydrarthrosis. Tests for rheumatoid factor and antibodies against cyclic citrullinated peptides were negative, but antinuclear antibody was positive. MRI of the right TMJ showed clear joint effusion, and condylar bone marrow abnormality. Arthrocentesis and lavage of the TMJ relieved the joint pain, and the range of mouth opening improved to between 42 and 46 mm, along with symptomatic improvement. Pain of the TMJ and other joints has been well controlled with antirheumatic drugs.

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