How can rheumatoid arthritis affect the jaw?

Rheumatoid arthritis (RA) causes pain and inflammation in the joints. When RA affects the jaw, it often causes tenderness, stiffness, and pain when chewing. In the advanced stages of the condition, the joint may be painful and make noises when moving.

Jaw involvement is common in people who have difficulties managing their RA. Although estimates of its prevalence vary widely between 2% and 88% of those with RA, only a small number of individuals experience symptoms.

RA usually affects the joints symmetrically, so people may notice the symptoms on both sides of the jaw.

This article will examine how RA can affect the jaw, including its symptoms, diagnosis, and ways to relieve jaw pain relating to RA.

RA and the jaw

RA is a chronic inflammatory autoimmune disease that causes the immune system to attack healthy cells and tissues in and around the joints.

Although RA commonly affects the hands, wrist, and knees, it can also cause inflammation in the temporomandibular joint (TMJ), or jaw joint. If there is jaw involvement, it usually occurs later on in the course of the disease.

The inflammation due to RA can lead to pain and stiffness in the jaw, which can interfere with a person’s ability to eat, drink, speak, and sleep. RA can also interrupt jaw development in children.

Symptoms and diagnosis

Jaw pain rarely develops in the early stages of RA — the jaw is usually one of the last joints the condition can affect. People with RA should talk with a rheumatologist if they experience pain in new areas.

The symptoms of RA in the jaw include:

• an aching jaw
• pain, tenderness, or stiffness in the jaw joint
• a grinding, creaking, or crunching sound, known as crepitation
• limited range of motion
• decreased joint space
• erosion or bone loss on the affected joint
• misalignment of the jaw in advanced cases
• dizziness
• pain in the neck, ears, or eyes

At times, jaw stiffness can make it difficult to chew.

A rheumatologist will diagnose RA jaw pain according to a person’s medical history, current diagnosis, and symptoms. These healthcare specialists may also run one or more diagnostic tests to validate their diagnosis.

Diagnostic tests for RA jaw pain may include:

• a physical examination of the jaw and mouth
• X-rays of the jaw joint
• MRI scans
• blood tests to measure antibody levels and rule out infections

People who experience RA in their jaw usually get symptoms of the condition in other joints before they experience it in the jaw joint.

RA can also cause symptoms outside the joints. The general symptoms of RA include:

• fatigue
• sometimes, an RA-related fever
• loss of appetite

How to relieve RA jaw pain

Controlling the disease itself will help reduce RA jaw pain. Typically, doctors prescribe medications to help prevent tissue damage and slow the disease from progressing.

Medications that reduce inflammation, such as nonsteroidal anti-inflammatory drugs, can reduce painful inflammation in the jaw and elsewhere and are generally prescribed for 2 weeks.

Because RA medication generally slows down or stops the progression of the condition, it also reduces symptoms and can prevent permanent joint damage.

Prescription medications can include:

• corticosteroids
• disease-modifying antirheumatic drugs
• biologic medications, including:
  • tumor necrosis factor-alpha inhibitors
  • rituximab
  • abatacept
  • interleukin-6 inhibitors
• Janus kinase inhibitors

Certain jaw exercises may also help relieve RA symptoms. A person can speak with a doctor about the best types of exercises to do and when to do them, as overusing the jaw can worsen symptoms. Individuals should always warm up the jaw muscles first to prevent injury.

A rheumatologist may also refer a person to an oral medication specialist to evaluate and manage TMJ pain.

Home remedies can help with the immediate symptoms of jaw pain. However, these methods alone are not enough to treat RA. Even with mild symptoms, prolonged inflammation can still lead to permanent tissue damage, so it is important to keep taking prescribed RA medication.

People can use the following methods to help relieve RA jaw pain at home:

• applying a hot or cold compress
• eating soft foods or switching to a liquid diet for a few days
• avoiding crunchy, sticky, or chewy foods, such as nuts, croutons, caramel, and gum
• using a straw for drinking liquids
• avoiding opening the mouth too wide during flares
• avoiding clenching the jaw
• wearing a mouthguard during sleep

Outlook

RA causes inflammation, pain, and swelling in the synovial fluid between joints. In later stages of the condition, it can also affect the jaw.

Inflammation of the jaw can lead to persistent pain and a limited range of mobility. Without treatment, inflammation can damage the surrounding cartilage and bone tissue, which can lead to permanent damage.

Controlling RA with medications can reduce RA-related jaw pain. Different medications work better for different individuals, and people can speak with a doctor about the best course of treatment.

Eating hard, crunchy food or clenching the jaw can worsen RA jaw pain during flares. People can consider eating soft foods and applying a hot or cold compress to reduce jaw pain at home.