The use of etanercept as a non‐surgical treatment for temporomandibular joint psoriatric arthritis: a case report

• Published in: Australian dental journal Vol. 54; no. 2; pp. 161 - 165
• Main Authors: Lamazza, L, Guerra, F, Pezza, M, Messina, AM, Galluccio, A, Spink, M, De Biase, A
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2009; Wiley-Blackwell
• Subjects: Adult; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - drug therapy; Biological and medical sciences; Dentistry; Diseases of the osteoarticular system; Etanercept; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Humans; Immunoglobulin G - therapeutic use; Immunomodulators; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Non tumoral diseases; Otorhinolaryngology. Stomatology; Pharmacology. Drug treatments; psoriatic arthritis; Receptors, Tumor Necrosis Factor - therapeutic use; Temporomandibular Joint Disorders - drug therapy; Temporomandibular Joint Disorders - etiology; TMJ; Treatment Outcome; Human; Skin disease; Psoriasis; Diseases of the osteoarticular system; Temporomandibular joint; Inflammatory joint disease; Arthritis; Dentistry; Psoriatic arthritis; Spondylarthropathy; Case study; Immunomodulator; TMJ; Chronic; Treatment; Etanercept; Surgery; immunomodulators
• ISSN: 0045-0421; 1834-7819
• DOI: 10.1111/j.1834-7819.2009.01110.x

Psoriatic arthritis (PsA) is a chronic inflammatory disease of the skin and joints characterized by extensive intra‐articular bone resorption and silver‐red scaly plaques most commonly found on extensor surfaces of the skin. When this arthritis affects the temporomandibular joint (TMJ) and does not successfully halt in its early degenerative process, patients may undergo invasive joint reconstruction that irreversibly changes the TMJ physiologic joint dynamics. This study presents a case of TMJ PsA: anterior open bite, limited range of motion, and erythematous desquamative plaques of the upper limb extensors surfaces. The patient previously received non‐steroidal anti‐inflammatory drugs, immunosuppressors, and corticosteroids over a four‐year period while suffering the idiosyncratic drug side effects from long‐term therapy without improvement in joint function or rash resolution. The treatment team then chose etanercept, a synthetic fusion protein therapy that binds with tumor necrosis factor (TNF)‐alpha, to interrupt reactive inflammatory arthritis. The patient received the TNF‐alpha inhibitor monthly for two years. This last treatment led to full remission of both joint symptomatology and skin lesions. Our results should encourage general dental practitioners’ involvement in curing patients with psoriatic arthritis when it affects the TMJ.