Research on diagnosis of temporomandibular disorders using synovial fluid analysis

目的：本研究通过对颞下颌关节（TMJ）内紊乱（闭锁）和骨关节炎（OA）患者滑液的分析，探讨了TMJ内紊乱和软骨退化的早期征象。采用酶联免疫吸附法（ELISA）检测IL-1 β的含量，明胶酶谱法检测蛋白酶活性。结果：25例闭合性交锁TMJ（CL组）中9例髁突表面出现溶骨性改变。正常对照组颞下颌关节未见骨性改变。CL组滑液（SF）蛋白中的平均IL-1 β浓度为330.1 <plus-minus>- 347.7 pg/100 μ g蛋白，显著高于正常对照组（76.7 <plus-minus>- 95.3 pg/100 μ g SF-蛋白）。关节滑液中溶骨性改变的IL-1 β水平（531.8 <plus-minus>- 379.6 pg/100 mug SF蛋白）高于无骨性改变的（216.7 <plus-minus>- 280.1 pg/100 mug SF蛋白）。在7例颞下颌关节滑膜液中检测到分子量为50 kd的基质金属蛋白酶（MMP 3）活性，并呈高度增强状态。结论：颞下颌关节滑膜液中IL-1 β水平与OA变化呈正相关。在软骨退化的患者中检测到的MMP 3活性大大增加。这些发现表明，这两种变化可能是TMJ早期骨退化的重要标志，而这些变化是X线成像无法检测到的。

Purpose : This study investigated the early signs of synovitis and cartilage degradation by means of synovial fluid analysis in temporomandibular joints (TMJs) with internal derangement (closed lock) or osteoarthritis (OA).Patients and Methods : Synovial fluid was obtained from 25 TMJs in 22 patients diagnosed with closed lock and from 15 asymptomatic TMJs of 12 normal controls. IL-1beta concentrations were measured using enzyme-linked immunosorbent assay (ELISA), and proteinase activity was detected by means of gelatin enzymography.Results : Nine of the 25 TMJs with closed lock (CL group) exhibited osteolytic changes on the surface of the condyle. TMJs in the normal control group did not show any bony changes. Mean IL-1beta concentration in the synovial fluid (SF) protein in the CL group was 330.1 <plus-minus> 347.7 pg per 100 mug protein, which was significantly higher than in the normal control control (76.7 <plus-minus> 95.3 pg/100 mug SF-protein). Synovial fluid from the TMJs with osteolytic changes contained higher levels of IL-1beta (531.8 <plus-minus> 379.6 pg/100 mug SF-protein) than those without bony changes (216.7 <plus-minus> 280.1 pg/100 mug SF-protein). Matrix metalloproteinase (MMP) activity with a molecular weight of 50 kd (stromelysin or MMP3) was detected in a highly augmented form in two synovial fluid samples of seven closed lock pConclusion : The results suggest that IL-1beta levels in synovial fluid of the TMJ have a positive correlation with OA change. The MMP3 activity detected was greatly increased in patients with cartilage degradation. These findings suggest that both changes may be important markers of early bone deterioration in TMJs that are undetectable by radiograph imaging.