TMJ Rheumatoid Arthritis — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateOral MedicineTMJ Rheumatoid ArthritisORE Part 1

A panoramic radiograph shows bilateral condylar erosion with flattening of the articular surfaces and reduced joint space in a 50-year-old woman. She has morning stiffness of the joints and bilateral TMJ pain. She also has hand deformities. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Rheumatoid arthritis affecting the TMJ

The diagnosis is rheumatoid arthritis (RA) affecting the TMJ. The discriminating features are: (1) Bilateral condylar erosions—erosive changes are significantly more common in RA than in osteoarthritis, which presents with osteophytes rather than erosions. (2) Morning joint stiffness—a hallmark of inflammatory arthritis, not mechanical OA. (3) Polyarticular involvement—hand deformities alongside TMJ disease indicate a systemic inflammatory arthropathy; RA commonly affects the TMJ alongside peripheral joints. (4) Age and demographics—a 50-year-old woman fits the epidemiology of RA. While flattening and reduced joint space can occur in both RA and OA, the emphasis on erosion as the primary radiographic finding favours RA. OA typically shows osteophytes more prominently. Psoriatic arthritis, juvenile idiopathic arthritis, and gouty arthritis do not fit the clinical and radiographic pattern; JIA is excluded by age, and gout does not cause bilateral symmetric erosive TMJ disease.

Reference: Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis. PubMed (8734713); https://pubmed.ncbi.nlm.nih.gov/8734713/. Also supported by: A multidimensional analysis of temporomandibular joint and ankle joint erosion in inflammatory arthritis. PMC (12313558); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313558/