The Link Between Arthritis and Jaw Pain

Where do ankylosing spondylitis and other arthritis types fit in?

DElight/E+/Getty Images

Pain in the temporomandibular joint (TMJ), which connects the jaw to the skull, is a common problem affecting  more than 10 million Americans, according to Kelley's Textbook of Rheumatology. For a proper diagnosis, it is essential to identify the specific condition that is causing TMJ pain. Non-articular (i.e., non-joint) causes (such as parotitis, sinusitis, Trotter's syndrome and more) that can produce similar symptoms to TMJ must be ruled out initially.

Primarily, there are three types of conditions that produce TMJ pain: various types of arthritis, derangements of the intra-articular disk, and neoplasms.

Arthritis is considered the most painful condition that affects the temporomandibular joint. While osteoarthritis is the most common type of arthritis affecting the temporomandibular joint, the pain can be caused by rheumatoid arthritis or the spondyloarthropathies (like ankylosing spondylitis)—and less commonly by infectious arthritis, metabolic arthritis, or traumatic arthritis.

Spondyloarthropathies Associated With TMJ

With ankylosing spondylitis, it is estimated that about one-third of people with the disease develop temporomandibular joint disease, according to Kelley's Textbook of Rheumatology. Pain and limited jaw movement are the primary symptoms with erosive changes evident on imaging studies. Treatment is consistent with that for any ankylosing spondylitis case.

If ankylosis of the TMJ occurs, surgery may become necessary.

In cases where temporomandibular joint pain is associated with psoriatic arthritis, the symptoms mimic those of rheumatoid arthritis. There is similar pain, tenderness, limited range of motion, and crepitus, although often only one temporomandibular joint is involved.

The differential diagnosis typically involves evidence of psoriasis, x-ray evidence of erosive arthritis, and negative blood test results for rheumatoid factor. Treatment for psoriatic arthritis of the temporomandibular joint is akin to that for rheumatoid arthritis with the goal of controlling inflammation. Surgery may become necessary if ankylosis develops.

Reactive arthritis of the temporomandibular joint is notably more common in males than females. Again, the symptoms of pain, swelling, and limited range of motion of the TMJ are typical. Treatment is the same as other spondyloarthropathies with the addition of an antibiotic to manage the infection which triggered reactive arthritis.

Osteoarthritis of the Temporomandibular Joint

Osteoarthritis is not only the most common type of arthritis affecting the temporomandibular joint, it is considered the most common cause of pain in the joint. According to Kelley's Textbook of Rheumatology, it is estimated that 16 percent of the general population have symptoms of osteoarthritis of the temporomandibular joint.

About 44 percent of the population has x-ray evidence of the condition, but without symptoms.

Osteoarthritis of the temporomandibular joint is characterized by pain that increases with use of the joint, tenderness of the joint, limited range of motion, and clicking or popping. In advanced stages, crepitus becomes more prevalent. Most often, osteoarthritis of the temporomandibular joint is unilateral (i.e., on one side). Pain tends to be localized, without significant involvement of other joints.

Diagnosis is based on a patient's medical history, symptoms, and imaging studies. Treatment typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs).  Other treatment modalities may include heat applications, a soft diet, limiting movement of the jaw, or a bite appliance. If conservative medical treatment fails, surgery may be required.

Rheumatoid Arthritis of the Temporomandibular Joint

According to Kelley's Textbook of Rheumatology, more than 50 percent of people with rheumatoid arthritis have problems with their temporomandibular joint. It is not usually the first joint affected however. Generally, rheumatoid arthritis of the temporomandibular joint affects more women than men by a 3 to 1 ratio. It is also characteristic of juvenile inflammatory arthritis.

Rheumatoid arthritis of the temporomandibular joint is characterized by bilateral pain (i.e., both sides), swelling, tenderness, and limited mandibular movement. Symptoms tend to come and go periodically. Stiffness and pain are usually worse in the morning with this type of TMJ.

Diagnosis is based on symptoms, medical history, and tests that suggest or confirm rheumatoid arthritis (imaging studies and blood tests). Treatment for rheumatoid arthritis of the temporomandibular joint is like that for rheumatoid arthritis which affects other joints. Anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (DMARDs) are used to treat the condition, depending on the severity. Exercises are recommended to prevent greater loss of motion in the joint. Sometimes surgery is required to correct an anterior open bite.    


Temporomandibular Joint Pain. Daniel M. Laskin. Chapter 51. Kelley's Textbook of Rheumatology. Elsevier Saunders. Volume I.

Update on Current Care Guideline: Temporomandibular Disorders (TMD) Duodecim 2013.

Temporomandibular Joint Disorders. Buescher JJ et al. American Family Physician. November 2007.

Continue Reading