What is your inflammatory arthritis differential when a patient presents with unilateral TMJ synovitis?

The differential of TMJ disease depends on the age group. In the younger population, JIA must be very high on the differential. In adults, the differential includes RA, dermatomyositis, systemic sclerosis, systemic lupus erythematosis, and spondyloarthropathies (Ankylosing spondylitis and psoriatic arthritis). In all groups, a complete history and complete general and musculoskeletal examination is mandated to correctly identify which disorder is present.

In my personal experience, I have seen TMJ inflammation in children with JIA, adults who were JIA patients as children, spondyloarthropathy patients, and occasionally RA patients. Management depends on the presence of other joint involvement.

References:

1. O’Connor et al., PMID 28638693

2. Ab...

The question assumes that we are dealing with an inflammatory etiology. Here I agree with Dr. @Dr. First Last. However, when approaching the problem, particularly if the inflammation is unilateral, then infections must first be ruled out. Not uncommonly the organism may be unusual. The diagnosis can be made by aspiration and/or biopsy of the joint. Failure to rule out infection leads to a delay in diagnosis and appropriate treatment.

David Goddard, MD, FACP

Professor of Clinical Medicine
NYU Grossman School of Medicine