Prevalence of Temporomandibular Joint Dysfunction in Patients With Ankylosing Spondylitis

February 18, 2024 updated by: Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Prevalence of Temporomandibular Joint Dysfunction in Patients With Ankylosing Spondylitis and Comparison of the Findings With Healthy Controls

This study included 113 patients diagnosed with ankylosing spondylitis and 110 healthy volunteers. Participants in both groups were evaluated using the 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD)' diagnostic criteria. In addition, the relationship between temporomandibular joint dysfunction and disease activity was investigated in patients with ankylosing spondylitis.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Ankylosing spondylitis (AS) is a chronic, inflammatory disease with an unknown etiology that primarily affects the axial spine, especially the sacroiliac joints, and can also involve peripheral joints and extra-articular clinical manifestations. Complaints related to temporomandibular joint pathologies are commonly observed in the general population but more frequent in the group of patients diagnosed with ankylosing spondylitis compared to the average population. Although the mechanism of temporomandibular joint involvement in ankylosing spondylitis is not fully understood, destruction of the joint capsule or disk, synovitis in the joint, and craniovertebral postural changes have been suggested as possible mechanisms. In addition, pain due to temporomandibular joint dysfunction can significantly affect daily life activities, quality of life, social participation, and the emotional status of the individual. Determining the level of relationship between quality of life and psychological status will support the development of new interventions and treatment approaches to improve patient's quality of life further.

The age, gender, body mass index, marital status, duration of ankylosing spondylitis (AS) diagnosis, symptom onset, treatment for AS, occupation, smoking status, and Human Leukocyte Antigen (HLA)-B27 positivity status were recorded for the patient. The 'Diagnostic Criteria for Temporomandibular Disorders (DC/TMD),' published in 2014 and translated into Turkish in 2016, was used to assess the presence of temporomandibular joint dysfunction in the patients. This evaluation system consists of two parts: the clinical evaluation and examination findings of the current pathology on Axis I, and the psychosocial status of the disease on Axis II. The questions in the Symptom Questionnaire on the first axis were directed to the patient, and then the results were recorded by performing the examinations indicated on the examination form. The diagnosis was determined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) decision tree, and marked on the examination form. Two groups were created based on the decision tree: pain and joint disorders. Pain disorders were further subdivided into muscle pain, joint pain, and TMD-related headaches; muscle pain was further subdivided into local muscle pain, muscle-fascial pain, and referred muscle-fascial pain subgroups. Joint disorders were classified as disc displacement with reduction, disc displacement with reduction-intermittent locking, disc displacement without reduction-limited mouth opening, disc displacement without reduction-limited mouth opening, degenerative joint disease, and dislocation.

On Axis II, the patients were asked to mark the areas where they felt pain on the pain drawing form. The marked area was divided into categories according to its size. The level of experienced pain was evaluated with the Graded Chronic Pain Scale (GCPS), jaw function limitations were assessed with the Jaw Functional Limitation Scale-20 (JFLS-20), depression was evaluated with the Patient Health Questionnaire-9 (PHQ-9), anxiety was assessed with the General Anxiety Disorder 7 (GAD-7), physical symptoms were evaluated with the Patient Health Questionnaire-15 (PHQ-15), and parafunctional activities were evaluated with the Oral Behavior Checklist (OBC). Additionally, the relationship between the identified diagnosis and psychosocial factors, disease activity, and other disease-specific factors was investigated.

Study Type

Observational

Enrollment (Actual)

223

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Istanbul, Turkey
        • Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Probability Sample

Study Population

113 patients with ankylosing spondylitis were diagnosed and 110 healthy volunteers.

Description

Inclusion Criteria:

  • Patients diagnosed with Ankylosing Spondylitis according to the Modified New York Criteria between the ages of 18-75.
  • Healthy volunteers between the ages of 18 and 75.

Exclusion Criteria:

  • Changes in the treatment of ankylosing spondylitis within the last 6 months
  • Patients with pathology related to the temporomandibular joint and associated structures prior to the diagnosis of ankylosing spondylitis
  • Use of medication that affects bone metabolism
  • Presence of neurological or cognitive deficits
  • History of trauma, malignancy, infection, and surgery in the head and neck area
  • Presence of dental or periodontal pain
  • History of orthodontic treatment.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Ankylosing spondylitis group
The patients were selected on a randomized form among the patients with a diagnosis of AS according to the modified New York criteria who referred to Istanbul Physical Medicine Rehabilitation Training and Research Hospital.
Diagnostic test: Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I and II
The presence of temporomandibular joint dysfunction was evaluated using the diagnostic criteria for temporomandibular disorders (DC/TMD).
Healthy volunteers
Healthy volunteers between the ages of 18-75 were selected randomly.
Diagnostic test: Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I and II
The presence of temporomandibular joint dysfunction was evaluated using the diagnostic criteria for temporomandibular disorders (DC/TMD).

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I Symptom questionnaire
Time Frame: A single point in time (1 day)
The presence of temporomandibular joint dysfunction will be evaluated using the The questionnaire that investigates temporomandibular region pain and characteristics, joint sounds, and headache was used.
A single point in time (1 day)
Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) Axis I Clinical Examination Form questionnaire
Time Frame: A single point in time (1 day)
Clinical Examination form assesses the site of pain, incisal relationships, mouth opening position, mouth opening and closing movements, lateral and protrusive movements, jaw noise, joint locking, and evaluation of muscle and joint pain by palpation.
A single point in time (1 day)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)
Time Frame: A single point in time (1 day)
The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to assess the disease activity.
A single point in time (1 day)
Bath Ankylosing Spondylitis Functional Index (BASFI)
Time Frame: A single point in time (1 day)
Bath Ankylosing Spondylitis Functional Index (BASFI) is a tool used to assess the functional ability of patients with ankylosing spondylitis. It includes questions about the patient's ability to perform daily activities such as dressing, grooming, standing, and bending.
A single point in time (1 day)
The Bath Ankylosing Spondylitis Metrology Index (BASMI)
Time Frame: A single point in time (1 day)
The Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to assess spinal mobility. The Bath Ankylosing Spondylitis Metrology Index (BASMI) includes measurements of tragus-to-wall distance, intermalleolar distance, modified Schober's test, lateral flexion, and cervical rotation.
A single point in time (1 day)
DC/TMD Axis II-Pain Drawing questionnaire
Time Frame: A single point in time (1 day)
Pain Drawing which assesses pain location and spread.
A single point in time (1 day)
DC/TMD Axis II-Patient Health Questionnaire-9 (PHQ-9)
Time Frame: A single point in time (1 day)
Patient Health Questionnaire-9 (PHQ-9), which assesses depressed mood state.
A single point in time (1 day)
DC/TMD Axis II- Oral Behaviors Checklist (OBC)
Time Frame: A single point in time (1 day)
Oral Behaviors Checklist (OBC), which assesses parafunctional behaviors
A single point in time (1 day)
DC/TMD Axis II-Jaw Functional Limitation Scale-20 (JFLS-20)
Time Frame: A single point in time (1 day)
Jaw Functional Limitation Scale-20 (JFLS-20) , which assesses limitation of mastication, mobility and verbal end emotional expressions.
A single point in time (1 day)
DC/TMD Axis II-Patient Health Questionnaire-15 (PHQ-15)
Time Frame: A single point in time (1 day)
Patient Health Questionnaire-15, which assesses non-specific physical symptoms
A single point in time (1 day)
DC/TMD Axis II-Graded Chronic Pain Scale; GCPS v2.0
Time Frame: A single point in time (1 day)
Graded Chronic Pain Scale (GCPS) is a tool used to assess the severity and impact of chronic pain on a person's life. It involves rating the intensity of pain, as well as how much pain interferes with daily activities and quality of life.
A single point in time (1 day)
DC/TMD Axis II- General Anxiety Disorder 7 (GAD-7)
Time Frame: A single point in time (1 day)
The General Anxiety Disorder 7 (GAD-7) is a brief self-report questionnaire that is used to assess the severity of generalized anxiety disorder
A single point in time (1 day)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Investigators

  • Study Director: Fatma Nur Kesiktaş, Prof, Istanbul Physical Medicine Rehabilitation Training and Research Hospital

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 1, 2022

Primary Completion (Actual)

July 1, 2022

Study Completion (Actual)

April 1, 2023

Study Registration Dates

First Submitted

April 21, 2023

First Submitted That Met QC Criteria

May 1, 2023

First Posted (Actual)

May 3, 2023

Study Record Updates

Last Update Posted (Actual)

February 20, 2024

Last Update Submitted That Met QC Criteria

February 18, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IstanbulPRMTRH

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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