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Introduction: Spondyloarthritis (SpA) is a heterogeneous group of chronic inflammatory diseases, which occur under the influence of the environment in genetically predisposed individuals. It affects the spine, peripheral joints and temporomandibular joint (TMJ). Temporomandibular disorder (TMD) is also a heterogeneous group of inflammatory or degenerative TMJ diseases, which cause TMJ pain or masticatory dysfunction. Predisposing factors for TMD include parafunctional habits, emotional stress, anxiety, and depression. Inflammation is one of the most common causes of TMD. Aim of the study: To diagnose and determine the frequency of disc displacement and healthy TMJ in patients with SpA, to determine matrix metalloproteinase-3 (MMP- 3) and tumor necrosis factor α (TNF-α) in saliva and to compare general clinical features, disease activity parameters and functional status of patients, as well as laboratory parameters between study groups. Patients and methods. SpA patients aged 18 to 75 years we enrolled in a prospective observational study. Exclusion criteria in the study were the diagnoses of other reumatic diseases, acute infection, malignancy, grade III and IV heart failure, grade IV and V renal failure and significant liver lesion. A rheumatologist assessed current SpA activity (Bath Ankylosing Spondylitis Disease Activity Index, BASDAI ; the number of aching and swollen joints out of 68 or 66 joints, respectively ; pain intensity, analog visual scale from 1 to 100 of 100 mm ; duration of morning stiffness, minutes) and Bath Ankylosing Spondylitis Functional Index (BASFI). A doctor of dental medicine performed clinical examination of TMJ according to the Diagnostic Criteria for Temporomandibular Disorder, DC / TMD, which consists of axis I (Clinical Examination) and axis II (Symptom Questionnaire including a) List of Oral Adverse Habits ; b) General Anxiety Disorder, GAD-7 ; c) Patient Health Questionnaire, PHQ-15 ; d) Physical Symptoms, Patient Health Questionnaire, PHQ-9 for Depressive Disorder and Demographics). Erythrocyte sedimentation rate (ESR), C-reactive protein and antistreptolysin-O titre were analyzed usingautomated analyzator, whereas TNF-α and MMP-3 were quantified using ELISA. Results: 185 patients with SpA met the entry criterion, and 58 patients were excluded due to the exclusion criteria, while 7 patients did not want to participate in the study. 120 patients were examined, 50 of whom had healthy TMJ (41.7%), 45 patients had DD with reduction (37.5%), and 25 patients had other or overlapping TMJ diseases (20.8%). Patients with DD had higher values of ESR (P=0.01), C-reactive protein (P=0.04), antistreptolysin-O (P=0.03), MMP-3 (P=0.045), physical symptoms of the disease (P=0.000003), depression (P=0.0046) and anxiety (P=0.00009). Other parameters did not differ. Conclusion: SpA patients with DD had a higher degree of inflammation judging by laboratory parameters, salivary MMP-3, physical symptoms of the disease, and points assigned to anxiety and depression, compared to SpA patients with healthy TMJ. Acknowledgement: University of Rijeka supported the study by the grants Uni-ri-biomed-18-110 and Uni-ri-biomed-18-160. |
