Reduction of Temporomandibular Joint Pain after Treatment with a Combination of Methotrexate and Infliximab Is Associated with Changes in Synovial Fluid and Plasma Cytokines in Rheumatoid Arthritis

Vol. 180, No. 1, 2005

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Paper

Reduction of Temporomandibular Joint Pain after Treatment with a Combination of Methotrexate and Infliximab Is Associated with Changes in Synovial Fluid and Plasma Cytokines in Rheumatoid Arthritis
Sigvard Kopp^a, Per Alstergren^a, Sofia Ernestam^b, Silvi Nordahl^a, Pär Morin^a, Johan Bratt^b

^aDepartment of Clinical Oral Physiology, Institute of Odontology, Karolinska Institutet, and
^bKarolinska University Hospital, Department of Rheumatology, Huddinge, Sweden

Address of Corresponding Author

Cells Tissues Organs 2005;180:22-30 (DOI: 10.1159/000086195)

Key Words

Cytokines
Infliximab
Temporomandibular joint
Rheumatoid arthritis
Pain

Abstract

The aims were to investigate the effect of intravenous infusions of the tumor necrosis factor- alpha (TNF- alpha ) antibody infliximab on symptoms and signs of temporomandibular joint (TMJ) involvement in relation to effects on synovial fluid and plasma proinflammatory TNF- alpha , interleukin-1 beta (IL-1 beta ) and interleukin-6 as well as antiinflam matory soluble TNF receptor II (TNF-sRII), interleukin-1 receptor antagonist (IL-1ra), soluble IL-1 receptor II (IL-1sRII) and interleukin-10 (IL-10) in patients with active rheumatoid arthritis (RA). Nineteen patients with TMJ involvement taking methotrexate were included in the study. TMJ and general joint pain intensity as well as pain on mandibular movements, tenderness to digital palpation, pressure pain threshold and maximum mouth-opening capacity were assessed in a clinical examination. The effect of infliximab was assessed after 2 and 14 or 22 weeks. TMJ synovial fluid and venous blood were collected for cytokine analysis at all occasions while determination of erythrocyte sedimentation rate and C-reactive protein were performed at baseline and at long-term follow-up only. Reduction of TMJ pain was associated with raised levels of synovial fluid TNF-sRII and IL-1sRII as well as raised plasma levels of IL-1ra and IL-10. Decreased erythrocyte sedimentation rate was associated with decreased tenderness to digital palpation. Reduced general joint pain intensity was associated with reduced plasma levels of IL-6 and C-reactive protein. In conclusion, systemic treatment with a combination of infliximab and methotrexate reduces TMJ pain in RA in association with an increase in anti-inflammatory cytokines and receptors in synovial fluid and plasma.

Author Contacts

Prof. Sigvard Kopp
Department of Clinical Oral Physiology, Institute of Odontology
Karolinska Institutet, Box 4064
SE-141 04 Huddinge (Sweden)
Tel. +46 8 5248 8281, Fax +46 8 608 0881, E-Mail sigvard.kopp@ofa.ki.se

Article Information

Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 4, Number of References : 23

Medline Abstract (ID 16088130)

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