Monday, 10 November 2014

RA. What Else Can Go Wrong?

Last week a rheumatologist I saw for a volunteer project commented that they rarely see people whose jaws are affected by rheumatoid arthritis (RA) anymore. That's good news for people with a recent diagnosis. It seems I'm having an epidemic of doctors telling me that prospects are better now than they were when I was diagnosed.

If you have aggressive rheumatoid arthritis it often happens that damage is to joints happens very early, before you and your doctor manage to get it under control. This can result in problems in your neck and jaw which may become noticeable years later because those joints are among the last ones affected by RA. After 30 years of living with it I am an obvious candidate and that's what happened.
Last month I went to the dentist, a different one, just for a consultation. He is a dental surgeon who no longer operates, perhaps because his hospital closed down their dental surgery program.He says that I am doing better than my X-Rays would lead him to believe. Luckily my pain and function is not too bad.  He says that he sees this sometimes in people whose joints have deteriorated over a long time.

Luckily your joints can adjust gradually during this slow process and find sort of a work-around.  That's what has been happening and I hope it keeps on like that in my jaw.

At a meeting I found two friends with RA who also have jaw trouble. Janey saw a physio and he said that the muscles in her face were all knotted up and he helped her to ease them.  Now she can open her mouth up to three finger widths and before it was only one finger. 

Donna actually has avascular necrosis in her jaw, but even with that a physiotherapist is able to help her somewhat. It's a serious problem, being unable to open your mouth. That makes it easier to let someone else put their fingers in your mouth.

The first step in dealing with jaw deterioration is the use of conservative measures. These include physio, Nsaids, use of a mouthguard at night, pain management if necessary.  

The jaw, or temporomandibular joint (TMJ for short) has a condyle, which is a curved disc that the jawbone fits into. There should be space in that joint. Mine is flattened and bone on bone - no cartilage. 

Side view of skull with TMJ

As a last resort you can have joint replacement but so far I use the above conservative measures with the added instructions to stay away from eating large things like apples and pears, and to avoid hard crusty sandwiches. Who would ever expect their bones to wear out before the other organs?

                                           At least he has a cardboard bed in the corner

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