Temporomandibular joint pain: Relationship to internal derangement type, osteoarthrosis, and synovial fluid mediator level of tumor necrosis factor-alpha

Objectives. The purpose of this study was to investigate whether patients w ith temporomandibular joint (TMJ)-related pain classified as capsulitis/syn ovitis may be linked to magnetic resonance imaging (MRI) Findings of intern al derangement, osteoarthrosis, or the synovial fluid aspirate findings of tumor necrosis factor-alpha (TNF-alpha) level. Study design. The study comprised 23 patients with temporomandibular disord ers (TMD), who had nonchronic pain (pain onset less than or equal to 6 mont hs) and a unilateral TMJ-related diagnosis of capsulitis/synovitis. Bilater al sagittal and coronal magnetic resonance images were obtained to establis h the presence or absence of internal derangement, osteoarthrosis, or both. TMJ synovial fluid aspirates were obtained from the pain and contralateral nonpain sides to determine the TNF-alpha level. Results. Comparison of the TMI side-related data showed a significant relat ionship between the clinical TMD diagnosis of capsulitis/synovitis and the MRI diagnoses of TMJ internal derangement (P = .002) and of TMJ internal de rangement type(P = .04). The mean TNF-alpha level in synovial fluid aspirat es from TMJs assigned a clinical TMD diagnosis of capsulitis/synovitis was significantly higher than in those obtained from contralateral nonpain side s (P = .001). There was no correlation between the clinical diagnosis of ca psulitis/synovitis and the MRI diagnosis of TMJ osteoarthrosis (P = .13) or between the MRI diagnosis of TMJ osteoarthrosis and that of TMJ internal d erangement (P = .70) or TMI internal derangement type (P = .33). Conclusions. The results suggest that the TMJ pain condition of capsulitis/ synovitis is related to TMJ-side specific MRI diagnoses of internal derange ment and internal derangement type, and synovial fluid aspirate findings of TNF-alpha level. The data confirm the concept of elevated mediator level a s a diagnostic approach For patients presenting with TMJ-related pain. MRI and synovial fluid aspirates may be used as diagnostic methods for evaluati ng TMJ-related pain conditions.