Rheumatoid myositis, myth or reality? A clinical, imaging and histological study.

UNLABELLED: Rheumatoid myositis (RM) is still poorly characterized, albeit the concept of muscle involvement in rheumatoid arthritis (RA) is well-recognized as being driven by a wide range of causes including inflammation, drugs, impaired joint flexibility, sedentarism. OBJECTIVE: To describe clinical, serological, imaging and histological pattern of RM. MATERIALS AND METHODS: This is a retrospective study on eight RM selected from a cohort of one hundred and three RA systematically assessed for skeletal muscle involvement. Data collected included clinical, serum muscle enzymes, muscle imaging and biopsy (Hematoxylin-Eosin, modified Gömöri trichrome staining). RESULTS: Routine muscle histology indicated both non-specific muscle fiber damage (changes in fiber size and internal structure: pleomorphic mitochondria, dilated sarcotubular system, multiple internal or subsarcommal nuclei; abnormal fiber types distribution: trend towards type II; atrophy; degenerative/regenerative modifications) and the presence of inflammatory deposits in all patients (mild to moderate, patchy B- and T-cells infiltrates, mainly perivascular and endomysial, but also in the perimysial region classified as polymyositis-like deposits). High levels of serum muscle enzymes, abnormal EMG (short duration, small amplitude, polyphasic motor unit action potentials) without insertional activity and fibrillations, active inflammation on both Doppler ultrasound and MRI were commonly reported. CONCLUSIONS: Traditional analysis of muscle biopsy specimens (Hematoxylin-Eosin, modified Gömöri trichrome staining) is faraway unsatisfactory, only documenting changes in muscle fibers size, architecture, internal structure, and, possibly, detecting perivascular, perimysial or endomysial inflammatory deposits. Upcoming research should address the value of muscle imaging for the diagnosis and evaluation of treatment response and muscle function in rheumatoid myositis.

[Contributions to the methodology of study in the functional assessment of temporomandibular joint dysfunctional syndrome]. / Contributii la studiul metodologiei de evaluare functionala a articulatiei temporo-mandibulare în sindromul algo-disfunctional.

AIM: Dysfunctional syndrome of the temporomandibular joint through the complexity and variability of the symptoms may result in significant structural and functional changes leading from discomfort to disability and a negative impact on quality of life. MATERIALS AND METHODS: A prospective study was conducted between October 2009-December 2010, in 52 subjects diagnosed with rheumatoid arthritis and complaining of symptoms in the temporomandibular joint. The functional examination of the joint and muscle has included the assessment of the active range of motion, passive range of motion, resistance range of motions of the temporomandibular joint, dermatomes and the pain in the region of masseter, temporalis, median and lateral pterigoids, digastric, sternocleidomastoid and longus colli muscles. The ultrasound examination has included clinical aspects of alignment, shape, dynamics of the mandibular condyle, of the temporal fossa, aspects regarding the temporal and masseter muscles at rest and at contraction phases. RESULTS: The clinical examination highlighted the presence of pain at temporomandibular jointlevel for all tested pacients. The majority complained the pain from moderate to severe level. For the majorityof cases (59,60%) the pain stars spontaneously, during the day time (80,80%) and the night time (50,60%). Over 50% from the research cases complained cracks at the temporomandibular joint level released by a movement. At the oral and dental examination of the research group 55,8% from the tested pacients presented dental cavities toothless partially or totally duet o additionally overworking temporomandibular joint. The limitation of the range of motion is not the most important detected dysfunction, affecting approximately 30% of the cases that have been studied. Pain and spasm in a very large proportion are present in the masseter and temporal muscles regions. Atrophy is present in a lesser extent. The dysfunctional index shows an involvement of the temporomandibular joint, for over 45% of patients tested. The ultrasound examination revealed degenerative inflammatory lesions at a rate of 38.46%, inflammatory lesions at a rate of 28.85% and mixed lesions at a rate of 9.62%. CONCLUSIONS: The research regarding the clinical paraclinical and functional aspects of temporomandibular joint, permited to highlight the fact that rheumatic inflamatory and degenerative, pathology, characterises it self through a high index of morbidity and disability that lowers the life quality. Establishing a treatment plan involves customizing all clinical, functional and laboratory data.

Study on the effectiveness of the kinetic method in patients with rheumatic diseases and temporomandibular joint dysfunction.

UNLABELLED: Selecting the appropriate treatment decision is essential for achieving optimal results in the management of algo-dysfunctional syndrome of the temporo-mandibular joint (TMJD). The study aims to decide on the most effective (symptomatic control, preserved motility) kinetic program in patients with TMJ involvement. MATERIAL AND METHODS: prospective observational study on 83 consecutive patients with rheumatic diseases and TMJ dysfunction. Clinical assessment (pain, noises, muscle spasm, range of motion, ROM) was performed at baseline and after 3 months of specific kinetic rehabilitation program. Change in clinical parameters and TM3 index was reported, p<0.05. RESULTS: over 45% TMJ involvement at baseline as defined by TMJ index (mean value of 13.56) and only 36.66% at 3 months (p<0.05). Significant improvement in pain (presence, severity) was demonstrated at 3 moths (p<0.05): 18.05% spontaneous pain, 75.9% provoked pain, with 12.11% respectively 2.41% decreased in nocturnal respectively diurnal pain. Significant decrease (p<0.05) in joint noises at movements: 27.71% when opening and 12.04% when closing the mouth, 8.43 at protrusion and 3.61% at retraction, while 18% at the side movements. CONCLUSIONS: Complex accurate kinetic reeducation is mandatory for achieving correct posture (head, neck and trunk), normal mastication, swallowing and respiration, as well as correction of neuromuscular imbalances in patients with TMJD secondary to rheumatic disorders.