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TMD and Fibromyalgia — SCE Rheumatology MCQ

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EasySoft Tissue RheumatologyTMD and FibromyalgiaSCE Rheumatology

A 42-year-old woman with established fibromyalgia reports a dull bilateral pre-auricular ache that is worse on chewing, intermittent jaw clicking and difficulty opening her mouth fully. Examination shows tenderness over the temporomandibular joints and masticatory muscles. There is no oral swelling, focal tooth tenderness, peripheral synovitis, scalp tenderness or visual disturbance. What is the most likely diagnosis?

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Correct answer: A — Temporomandibular disorder

The diagnosis is temporomandibular disorder (TMD). Jaw or pre-auricular pain worsened by chewing, joint clicking, masticatory tenderness and restricted mouth opening are characteristic. TMD frequently coexists with fibromyalgia; a systematic review found TMD in approximately 77% of patients with fibromyalgia, particularly painful myogenous TMD. A dental abscess would usually cause localised dental pain or tenderness, often with swelling. Trigeminal neuralgia causes brief, electric shock-like unilateral facial pain rather than a persistent mechanical ache. Rheumatoid TMJ disease would be more likely with established inflammatory polyarthritis or synovitis. Giant cell arteritis is exceptionally unlikely at age 42 and causes exertional jaw claudication, usually with other cranial or systemic features, rather than clicking and restricted opening.

Reference: Yakkaphan P et al. Temporomandibular Disorders and Fibromyalgia Prevalence: A Systematic Review and Meta-Analysis. Journal of Oral & Facial Pain and Headache. 2023;37(3):177-193. https://pubmed.ncbi.nlm.nih.gov/37975782/