INTRAARTICULAR LEVELS OF PROSTAGLANDIN E-2, HYALURONIC-ACID, AND CHONDROITIN-4 AND CHONDROITIN-6 SULFATES IN THE TEMPOROMANDIBULAR-JOINT SYNOVIAL-FLUID OF PATIENTS WITH INTERNAL DERANGEMENT

Purpose: This study was conducted to measure the intra-articular level s of prostaglandin E-2 (PGE(2)), hyaluronic acid, and chondroitin-4 an d -6 sulfate in patients with temporomandibular joint (TMJ) internal d erangement involving a closed lock, and to see if these levels correla te with the clinical or arthroscopic findings. Patients and Methods: F ifteen female patients (16 joints) with a mean age of 36.7 years were diagnosed as having a closed lock by clinical examination and diagnost ic MR imaging. The patient's subjective pain was assessed by a visual analog scale (VAS) and a pain questionnaire (pain score), and the inte rincisal opening was measured. TMJ aspirates were obtained by washing of the joint with saline containing vitamin B-12 as a marker for calib ration of data. The samples were assayed for PGE(2) with a radioimmuno assay, and the concentrations of-unsaturated disaccaride isomers of hy aluronic acid (Delta di-HA), chondroitin-4 sulfate (Delta di-4S), and chondroitin-6 sulfate (Delta di-GS) were measured by highperformance l iquid chromatography. Immediately after collection of the synovial asp irates, diagnostic arthroscopy was performed on all but three joints t o evaluate the severity of synovitis and cartilage degeneration. The d egree of arthroscopic pathology was scored quantitatively. Intra-artic ular levels of PGE(2), Delta di-HA(HA), Delta di-4S(C4S), and Delta di -6S(C6S) were compared with patient's age, mouth opening, VAS rating, pain scores, and arthroscopic scores for synovitis and cartilage degen eration. Results: The PGE(2) level did not correlate with the clinical or arthroscopic parameters. KA. had a weak correlation with mouth ope ning (0.54). C4S and CGS were correlated with arthroscopic scores of T MJ degeneration (0.97, 0.89) and with age (0.75, 0.62). The ratio of C 4S and CGS to HA was also correlated with the arthroscopic indices of degeneration (0.93, 0.8) and PGE(2) level (0.74, 0.69), but not with a ge. Conclusion: The PGE(2) level in the TMJ synovial fluid does not sp ecifically reflect the intensity of pain or synovitis, but the detecti on of high concentrations of C4S and CGS, compared with the amount of HA, is a possible marker of proteoglycan degradation in the TMJ.