Temporomandibular Joint Synovial Fluid Components Levels: Implications for Arthrocentesis Outcome

Aim: The aim was to evaluate cytological and biochemical findings in the first synovial fluid (SF) aspirate as well in venous blood samples and to estimate the effect of arthrocentesis in the treatment of TMJ disorders. Patients and Methods: Thirty four patients with TMJ involvement (23 with osteoarthritis and 11 with rheumatoid arthritis, Wilkes ́ stages III, IV) after noneffective conservative treatment were treated with arthrocentesis using push and pull technique. The first synovial fluid aspirate (SF) was analysed for presence of crystals, rheumatoid factor (RF), PGE2, glucose level, number of erythrocytes and lymphocytes with cytological investigation. The levels of glucose, RF, CRP, ESR in venous blood were analysed. Preoperative radiographs and the scores preand posttreatment (after 6 months) maximal interincisal opening (MIO) for mandibular movement and visual analogue scale (VAS) for pain estimation were performed. Results: After 6 months MIO improved significantly (p < 0.001) and pain according to VAS had substantially decreased (p = 0.016). Crystals/granules were found in 6 patients (17.6%). There were not statistical significant differences between SF RF and plasma RF values (p > 0.05). Several correlations between the variables were found. Conclusions: The presence of crystals or chondromatosis granules in the synovial fluid, and presence of high level of PGE2 indicates a pathological condition of an inflammatory nature. Arthrocentesis with push and pull technique for the treatment of TMJ disorders offer favourable results with regard to increasing jaw motion and improving function.