engleski

Temporomandibular joint involvement in Lyme borreliosis – a reported case.

Aims. The aim of this paper is to analyze the involvement of the temporomandibular joint (TMJ) in seronegative reactive spondyloarthropaty caused by Lyme disease or borreliosis. Methods: In a prospective study of TMJ disorders, the data were collected from 25 patients with systemic inflammatory rheumatic disease (mean age 53.2 years) between 2001 and 2015. Each patient experienced TMJ pain measured on a visual analogue scale (VAS ; ranging from 0 to 10). The diagnosis of TMJ was confirmed by magnetic resonance imaging (MRI). Results: TMJ disorders were attributed to the following diagnoses of rheumatic inflammatory diseases (number ; % of patients): rheumatoid arthritis (8 ; 32%), psoriatic arthritis (5 ; 20%), seronegative spondyloarthropathies (7 ; 28%), Sjögren's syndrome (3 ; 12%) and mixed connective tissue diseases and Crohn's disease to one patient (4%). We report a case of a 48-year- old female patient with seronegative reactive spondyloarthropaty. Lyme borreliosis occurred as a subfebrile condition (up to 37.7°C) about twelve days after tick bite at her right upper leg. She had pain in the lumbar region palpatory pain in the presacral region at S-2 vertebral level with mild edema and without clearly expressed erythema migrans. The patient’s laboratory test showed a border sedimentation rate of 28 mm/h. Also migrating mialgias have developed towards the pubic region of the buttocks and the lower back, the pain in the lower back followed by a subfebrile condition. Computerized tomography showed left-sided sacrolilitis. The serological examinations for Borreelia burgdorferi showed IgM antibody borderline results and IgM antibody positive results. The first orofacial complaints which occurred a month after symptoms of Lyme disease included a reduced mobility of the mandible, pain of right TMJ when chewing. Pain in the TMJ was moderately strong (VAS = 6.5). MRI of the right TMJ showed arthritic changes and nonreduced anteriorly displaced disc with the presence of inflammatory synovial fluid. Doxycycline for 30 day has been used to treat certain joint manifestations of Lyme disease. The McKenzie method of physical therapy for TMJ pain was applied. The exercise helped relieve pain in TMJ during a 12-month-folow-up. Conclusion: Although the large joints are most typically affected in Lyme borreliosis, there are also periods of disease activity involving smaller joints, including the TMJ.

temporomandibular joint ; seronegative reactive spondyloarthropaty ; Lyme disease ; borreliosis

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