Treatment of inflammatory temporomandibular joint disorders with Erbium-169-Colloid radiosynoviorthesis

Objectives Pain in the temporomandibular joint (TMJ) is often of multifactorial origin and long-term consequence of prolonged periods of malfunction. Inflammatory arthritis which among other can be observed in rheumatoid arthritis is a common cause of complaints located in the TMJ. The largest group of affected patients are those with TMJ syndrome which most commonly can be treated with pharmacotherapy, splints etc. A further option for therapy is the minimal invasive radiosynoviorthesis (RSO) with Erbium-169-Colloid.

Methods 9 TMJs in 6 patients were treated with 40 MBq Erbium-169-colloid. Pretreatment 3-phase-bone-szintigraphy revealed inflammatory disease of the TMJ. The underlying diseases were spondylitis ancylosans, psoriasis, activated TMJ arthritis. After therapy patients evaluated the degree of clinical change using a five scale score: major improvement, minor improvement, no change, minor deterioration, major deterioration. They also subjectively assessed the mouth opening before and after therapy.

Results The patients with spondylitis ancylosans and psoriasis arthritis with a total of three treated joints reported a major improvement (33.3 %), three patients described a minor improvement (55.5 %) but noticed a gradual reincrease of pain symptoms in the TMJ in the months following treatment. In degenerative TMJ osteoarthritis RSO treatment showed no change (11.1 %) of symptoms at all . The improvement in TMJ pain was associated with a parallel improvement of the opening of the mouth. In none of the cases deterioration of complaints occurred.

Conclusions Clinical efficacy of TMJ-RSO could be demonstrated by pain reduction in almost all patients (87,5%). In degenerative osteoarthritis of the TMJ treatment was effective in those cases where a reactive synovialitis was diagnosed prior to treatment using 3-phase-bone-szintigraphy. Unregarded the limited number of underlying cases the good clinical results should encourage further investigations of the TMJ-RSO with Erbium-169-Colloid