Temporomandibular joint deformities and atlantoaxial impaction in rheumatoid arthritis

Abstract

ABSTRACT Rheumatoid arthritis is the most common type of autoimmune arthritis characterized by inflammation of the synovial membranes. Even though any articulation can be involved, temporomandibular joints are considered among the last ones to be affected. Cervical spine involvement is also considered a feature of long-standing disease, atlantoaxial impaction with vertical subluxation of the odontoid process through the foramen magnum being one of the most serious complications. Hereby we report a 44-year old patient with rheumatoid arthritis who presented with increasing headaches for several months. Medical imaging investigation revealed severe deformities of both temporomandibular joints and an upward displacement of the odontoid process above the foramen magnum consistent with atlantoaxial impaction. Relevant findings that can be obtained by different imaging modalities and potential therapeutic strategies are also discussed.