chondroitin-sulfates and Temporomandibular-Joint-Disorders

The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection. A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author's clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively. Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05). Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups. These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.

Topics: Adolescent; Adult; Arthrocentesis; Chondroitin Sulfates; Dietary Supplements; Dimethyl Sulfoxide; Glucosamine; Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Range of Motion, Articular; Sulfones; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome; Young Adult

Previous studies have shown chondroitin sulfate and glucosamine hydrochloride have beneficial effects on symptoms of osteoarthritis of the knee. Our aim was to study the effect of a daily dose of 1500 mg of glucosamine hydrochloride (GH) and 1200 mg of chondroitin sulfate (CS) taken for twelve weeks on subjects diagnosed with capsulitis, disk displacement, disk dislocation, or painful osteoarthritis of the temporomandibular joint (TMJ). Forty-five subjects were enrolled in the study and were randomly assigned to either an active medication group or a placebo group. Eleven subjects were lost from the study for various reasons, resulting in fourteen subjects remaining in the active medication group and twenty subjects remaining in the placebo group. Subjects taking CS-GH had improvements in their pain as measured by one index of the McGill Pain Questionnaire, in TMJ tenderness, in TMJ sounds, and in the number of daily over-the-counter medications needed. Subjects taking the placebo medication had improvements in their pains as measured by the visual analog scale and by four indices of the McGill Pain Questionnaire. Additional studies are required to evaluate the clinical effectiveness of CS-GH and to determine the exact mechanism by which CS-GH affects the articular cartilage of synovial joints.

Topics: Adult; Affect; Analgesics; Analysis of Variance; Bursitis; Cartilage, Articular; Chi-Square Distribution; Chondroitin Sulfates; Double-Blind Method; Drug Combinations; Female; Follow-Up Studies; Glucosamine; Humans; Joint Dislocations; Male; Middle Aged; Movement; Osteoarthritis; Pain Measurement; Pilot Projects; Placebos; Range of Motion, Articular; Statistics as Topic; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

Evaluation of the effect of glucosamine-chondroitin combination, tramadol, and sodium hyaluronic acid in temporomandibular joint (TMJ) disorders and its impact on the expression of various cytokines such as IL-6, IL-1β, TNF-α, and PGE2.. The present study was conducted on 60 patients (males-30, females-30) suffering from internal derangement such as disc displacement with reduction of TMJ. The patients were divided into three groups of 20 each. Group I received a combination of 1.5g of glucosamine and 1.2 g of chondroitin sulfate per day and group II received 50 mg tramadol HCL peroral. Group III received sodium hyaluronate 10 mg/mL, 2 mL injection syringe on each joint. Pain (VAS) scale and maximum mouth opening (MMO) was measured. The level of IL-6, IL-1β, TNF-α, and PGE2 levels were measured using Enzyme-linked immuno sorbent assay (ELISA).. There was an improvement in maximum mouth opening in all three groups (p < 0.05). There was a reduction in pain in all groups. IL- 1β, TNF-α, and PGE2 leve ls showed reduction while IL-6 showed an increase in value in group II and III.. The efficacy of glucosamine chondroitin sulfate , tramadol and hyaluronic acid in TMJ disorders has been found to be effective.. IL-6, IL-1β, TNF-α, and PGE2 levels indicate the risk of TMJ disorders. Thus earlier assessment of their levels helps in diagnosis, and better management may be done.

Topics: Biomarkers; Chondroitin Sulfates; Dinoprostone; Facial Pain; Female; Glucosamine; Humans; Hyaluronic Acid; Inflammation Mediators; Interleukin-1beta; Interleukin-6; Male; Temporomandibular Joint Disorders; Tramadol; Treatment Outcome; Tumor Necrosis Factor-alpha

Results from our previous studies suggest that surgical induction of anterior disk displacement (ADD) in the rabbit craniomandibular joint (CMJ) leads to histopathological alterations consistent with osteoarthritis. In addition, molecular changes in collagens and glycosaminoglycans (GAGs) were observed using immunohistochemistry. The purpose of the present study was to further characterize those molecular changes in collagens and GAGs using immuno-electron microscopy.. The right joint of 15 rabbits was exposed surgically and all discal attachments were cut except for the posterior attachment (the bilaminar zone). The disc was then repositioned anteriorly and sutured to the zygomatic arch. The left joint was used as a sham-operated control. Ten additional joints were used as non-operated controls. Mandibular condyles were removed 2 weeks following surgery and processed for light and immuno-electron microscopy using colloidal gold-labeled antibodies against collagen type I, II, VI and IX and against keratan sulfate, chondroitin-4 and -6-sulfate, and link protein.. Light microscopic results showed osteoarthritic changes. Immuno-electron microscopy of osteoarthritic cartilage demonstrated a decline in type II collagen, the abnormal presence of type I collagen and loss of type VI and IX collagens. Quantitative colloidal gold immuno-electron microscopy confirmed the depletion of keratan sulfate, chondroitin-4 and -6-sulfate, and link protein in osteoarthritic cartilage.. Anterior disk displacement leads to molecular alterations in both the collagen and the proteoglycans of rabbit condylar cartilage characteristic of osteoarthritis in other synovial joints. These alterations are consistent with loss of the shock absorber function of the cartilage and injury of the underlying bone.

Topics: Animals; Antibodies; Cartilage; Chondroitin Sulfates; Collagen; Collagen Type I; Collagen Type II; Collagen Type IX; Collagen Type VI; Extracellular Matrix Proteins; Gold Colloid; Immunohistochemistry; Joint Dislocations; Keratan Sulfate; Male; Mandibular Condyle; Microscopy, Immunoelectron; Osteoarthritis; Proteins; Proteoglycans; Rabbits; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

The aim was to investigate the content of 4- and 6-sulphated glycosaminoglycans (GAGs) in specimens from temporomandibular joint disc and posterior disc attachment in patients with painful clicking and chronic closed lock. Nineteen patients (19 joints) with a clinical diagnosis of painful clicking were compared with 22 patients (22 joints) with a clinical diagnosis of chronic closed lock. Specimens were obtained from the disc and the posterior disc attachment, and their content of glycosaminoglycans analysed by means of capillary zone electrophoresis. These were significant differences in the amount of glycosaminoglycans between the two groups, values in patients with painful clicking being comparable to those of normal individuals, while patients having chronic closed lock showed significantly reduced values. Both groups showed higher values in the posterior disc attachment when compared to the disc and similar pattern of glycosaminoglycan sulphation. The results suggest that these two patient groups have distinctly different patterns of tissue reactions. In patients with chronic closed lock there was an altered composition of matrix, this change involving both disc and posterior disc attachment.

Topics: Adolescent; Adult; Aged; Chondroitin Sulfates; Chronic Disease; Electrophoresis, Capillary; Female; Humans; Joint Dislocations; Male; Matched-Pair Analysis; Middle Aged; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

The aetiology of temporomandibular joint (TMJ) disc displacement has been investigated using human post-mortem material. Twenty TMJ specimens were used for a histological procedure with haematoxylin and eosin staining and orcein staining. Immunohistological analysis with chondroitin-6-sulphate and keratan sulphate was also carried out on the same specimens. Immunohistochemically, the specific localization of chondroitin-6-sulphate and keratan sulphate in the antero-medial parts of the anteriorly displaced deformed TMJ disc, which may be load-bearing areas, was observed. Orcein staining revealed that specific elastic fibres pulling the anterior band and stretching the disc continuously, may be an important factor in disc displacement. On the basis of these results, we were able to propose a significant new hypothesis for the aetiology of disc displacement.

Topics: Adult; Aged; Aged, 80 and over; Chondroitin Sulfates; Elastic Tissue; Extracellular Matrix; Female; Humans; Immunoenzyme Techniques; Joint Dislocations; Keratan Sulfate; Male; Middle Aged; Pterygoid Muscles; Synovial Membrane; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

This study was conducted to measure the intra-articular levels of prostaglandin E2 (PGE2), hyaluronic acid, and chondroitin-4 and -6 sulfate in patients with temporomandibular joint (TMJ) internal derangement involving a closed lock, and to see if these levels correlate with the clinical or arthroscopic findings.. Fifteen female patients (16 joints) with a mean age of 36.7 years were diagnosed as having a closed lock by clinical examination and diagnostic MR imaging. The patient's subjective pain was assessed by a visual analog scale (VAS) and a pain questionnaire (pain score), and the interincisal opening was measured. TMJ aspirates were obtained by washing of the joint with saline containing vitamin B12 as a marker for calibration of data. The samples were assayed for PGE2 with a radioimmunoassay, and the concentrations of unsaturated disaccaride isomers of hyaluronic acid (delta di-HA), chondroitin-4 sulfate (delta di-4S), and chondroitin-6 sulfate (delta di-6S) were measured by high-performance liquid chromatography. Immediately after collection of the synovial aspirates, diagnostic arthroscopy was performed on all but three joints to evaluate the severity of synovitis and cartilage degeneration. The degree of arthroscopic pathology was scored quantitatively. Intra-articular levels of PGE2, delta di-HA(HA), delta di-4S(C4S), and delta di-6S(C6S) were compared with patient's age, mouth opening, VAS rating, pain scores, and arthroscopic scores for synovitis and cartilage degeneration.. The PGE2 level did not correlate with the clinical or arthroscopic parameters. HA had a weak correlation with mouth opening (0.54). C4S and C6S were correlated with arthroscopic scores of TMJ degeneration (0.97, 0.89) and with age (0.75, 0.62). The ratio of C4S and C6S to HA was also correlated with the arthroscopic indices of degeneration (0.93, 0.8) and PGE2 level (0.74, 0.69), but not with age.. The PGE2 level in the TMJ synovial fluid does not specifically reflect the intensity of pain or synovitis, but the detection of high concentrations of C4S and C6S, compared with the amount of HA, is a possible marker of proteoglycan degradation in the TMJ.

Topics: Adolescent; Adult; Arthroscopy; Biomarkers; Cartilage; Chondroitin Sulfates; Dinoprostone; Facial Pain; Female; Humans; Hyaluronic Acid; Joint Dislocations; Middle Aged; Osteoarthritis; Pain Measurement; Range of Motion, Articular; Statistics, Nonparametric; Surveys and Questionnaires; Synovial Fluid; Synovitis; Temporomandibular Joint; Temporomandibular Joint Disorders

The specific aim of this investigation was to assess differences between primary and secondary osteoarthritis (OA) of the temporomandibular joint (TMJ) using clinical evaluation and synovial fluid analysis for proteoglycans.. Arthroscopic surgery was performed on 101 TMJs from patients with significant pain or dysfunction and who had failed to respond to treatment. Joints were assessed for primary and secondary osteoarthritis. Synovial fluid aspirates were obtained and analyzed to determine the levels of keratan sulfate (KS) epitope and a novel 3B3(-) epitope by enzyme-linked immunosorbent assay (ELISA).. Fifty-four patients and 67 joints had OA diagnosed by both clinical examination and arthroscopy. Primary OA was diagnosed in 14 joints (20%), and the remaining 53 joints were regarded as having secondary OA. No differences were detected in the levels of KS in the synovial fluid from the primary and secondary OA joints. Furthermore, the 3B3(-) epitope was not detectable in the synovial fluid aspirates of any TMJ.. Secondary OA is a common disorder of the TMJ. However, there is no apparent difference in the metabolism of the joints with primary and secondary OA as assessed by proteoglycans in the synovial fluid. The apparent absence of the 3b3(-) epitope, in contrast to its presence in OA of other major synovial joints, suggests that there are some differences between the cartilage metabolism of the TMJ and these other joints during OA.

Topics: Adult; Arthroscopy; Cartilage; Chondroitin Sulfates; Enzyme-Linked Immunosorbent Assay; Epitopes; Female; Humans; Keratan Sulfate; Male; Osteoarthritis; Proteoglycans; Statistics, Nonparametric; Synovial Fluid; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

This study investigated the correlation between temporomandibular joint (TMJ) disease and the composition of glycosaminoglycans (GAGs) components in the synovial fluid (SF).. Synovial fluid (SF) was obtained from 30 TMJs of 28 female patients diagnosed as having a displaced disc with reduction (WR) (seven joints), a displaced disc without reduction (WOR) (13 joints), osteoarthritis (OA) (five joints), or rheumatoid arthritis (RA) (five joints) by MR imaging and clinical examination. After the SF was directly aspirated, It was digested with chondroitinase ABC and hyaluronidase, and the concentration of unsaturated disaccharide isomers of chondroitin 6-sulfate (delta di-6S), chondroitin 4-sulfate (delta di-4S) and hyaluronic acid (delta di-HA) were measured by high-performance liquid chromatography (HPLC) combined with fluorometry. The ratio of delta di-6S or delta di-4S to delta di-HA, and delta di-6S to delta di-4S, were calculated.. There were no significant differences in concentrations of delta di-6S, delta di-4S, or delta di-HA among the groups. The ratio of delta di-6S to delta di-4S was 2.7 +/- 1.4 in OA, 2.6 +/- 0.9 in joints with WOR, 2.9 +/- 1.2 in joints with WR, and 1.3 +/- 0.4 in RA synovial fluid. Differences in the delta di-6S: delta di-4S ratio between RA and the other conditions were statistically significant (P < .05).. These results suggest that the delta di-6S:delta di-4S ratio in the synovial fluid of the TMJ reflects the proteoglycan metabolism of the joint tissues, particularly of the articular cartilage and synovial tissue. This ratio could be used to diagnose joint diseases and to predict articular cartilage destruction or synovial proliferation caused by these diseases.

Topics: Adult; Arthritis, Rheumatoid; Chondroitin Sulfates; Chromatography, High Pressure Liquid; Disaccharides; Female; Fluorometry; Glycosaminoglycans; Humans; Hyaluronic Acid; Joint Dislocations; Middle Aged; Osteoarthritis; Paracentesis; Statistics, Nonparametric; Synovial Fluid; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders

The signs and symptoms of osteoarthritis are common complaints seen in patients suffering with chronic temporomandibular disorders (TMD), specifically, internal derangements with a diagnosis of osteoarthritis. With or without the complaints of pain and swelling, joint noises are bothersome and annoying to both the patient and at times, to those seated close to the patient during mealtime. In fact, many patients are driven to seek care by family members because of his or her TMJ noises. For years in veterinarian medicine, glucosamine and chondroitin sulfates have been used to treat symptoms of osteoarthritis. Recently, the use of these two supplements has been recommended for human beings as well. Reports of decreased joint noises, pain and swelling after the administration of therapeutic doses of these supplements have sparked an interest in their possible use in the treatment of osteoarthritis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Ascorbic Acid; Chondrogenesis; Chondroitin Sulfates; Female; Glucosamine; Humans; Male; Middle Aged; Osteoarthritis; Temporomandibular Joint Disorders

Synovial fluid was collected from the superior articular cavity of the temporomandibular joint in patients with unilateral internal derangement and joint pain whose contralateral joint was healthy. Glycosaminoglycans were liberated by digestion with pronase E, and precipitated with cetylpyridinium chloride and ethanol. Unsaturated disaccharide isomers of chondroitin sulfate, obtained following chondroitinase ACII digestion, were analyzed by high-performance liquid chromatography. Analytic data indicated that deltaDi-0S and deltaDi-6S were often found in chondroitin sulfate from the fluid of the diseased joints. The amounts of deltaDi-0S and deltaDi-6S differed significantly between synovial fluid samples from the diseased and healthy joints. Comparison of the relative proportions of the unsaturated disaccharides in the synovial fluid with previously reported values for several tissues, indicated that the chondroitin sulfate originated from articular cartilage, with possibly some contributions from soft connective tissues and serum present in the synovial fluid. These results suggest that chondroitin sulfate in the synovial fluid provides a useful indicator of the degree of internal derangement of the temporomandibular joint.

Topics: Adult; Blood; Cartilage, Articular; Cetylpyridinium; Chemical Precipitation; Chondroitin Lyases; Chondroitin Sulfates; Chromatography, High Pressure Liquid; Connective Tissue; Detergents; Disaccharides; Ethanol; Female; Humans; Isomerism; Pronase; Solvents; Synovial Fluid; Temporomandibular Joint; Temporomandibular Joint Disorders

The purpose of this study was to determine the effects of surgically induced anterior disc displacement (ADD) on sulfated glycosaminoglycans (GAGs) such as keratan sulfate (KS), chondroitin-4-sulfate (C4S), and chondroitin-6-sulfate (C6S), hyaluronic acid (HA), and link protein (LP) of the rabbit craniomandibular joint (CMJ) using histochemical and immunohistochemical techniques.. The right joint of 20 rabbits was exposed surgically, and all discal attachments were severed except for the posterior attachment. The disc was then repositioned anteriorly and sutured to the zygomatic arch. The left joint served as a sham-operated control. Ten additional joints were used as nonoperated controls. Deeply anesthetized rabbits were perfused with 2% buffered formalin 2 weeks (10 rabbits) or 6 weeks (10 rabbits) after surgery. Discs, bilaminar zones, condyles, and articular eminences were excised. Condyles and articular eminences were decalcified in ethylenediaminetetraacetic acid (EDTA). All tissues were sectioned at 10 microns in a cryostat. Sections were incubated with alcian blue and monoclonal antibodies directed against KS, C4S, C6S, HA, or LP. After incubation in the appropriate fluorescein isothiocyanate (FITC)-labeled secondary antibodies, tissue sections were studied under the fluorescence microscope.. The results showed a reduction in alcian blue staining and KS, C4S, C6S, HA, and LP immunostaining in the disc and articular surfaces at 2 weeks after induction of ADD. This reduction was followed by an increase in their immunostaining at 6 weeks. Also, there was a progressive increase in alcian blue staining, and KS, C4S, C6S, and HA immunostaining in the bilaminar zone at 2 and 6 weeks.. It was concluded that surgical induction of ADD in the rabbit CMJ leads to alterations in KS, C4S, C6S, HA, and LP content, consistent with similar changes accompanying osteoarthritis of other synovial joints.

Topics: Alcian Blue; Animals; Cartilage, Articular; Chondroitin Sulfates; Coloring Agents; Extracellular Matrix Proteins; Fluorescein-5-isothiocyanate; Fluorescent Dyes; Glycosaminoglycans; Histocytochemistry; Hyaluronic Acid; Immunohistochemistry; Joint Dislocations; Keratan Sulfate; Male; Mandibular Condyle; Microscopy, Fluorescence; Proteins; Proteoglycans; Rabbits; Temporal Bone; Temporomandibular Joint Disorders

Glycosaminoglycans in normal and osteoarthrotic temporomandibular joint disks were studied by means of high-performance liquid chromatography methods. Normal disk tissue contains galactosaminoglycans (chondroitin sulfate and dermatan sulfate) as the main polysaccharides and with smaller amounts of hyaluronate and heparan sulfate. The galactosaminoglycans are mainly sulfated in 6-position, and some of the disaccharides contain iduronic acid. There was a slight general variation in glycosaminoglycan concentration with increasing age. In the severely arthrotic disks the content of glycosaminoglycans was considerably lower than in normal disk tissue. This decrease was far more extensive than that observed in relation to age in normal tissue. The 4/6-sulfate ratio of the galactosaminoglycans was increased, whereas the proportion of iduronic acid was markedly decreased.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cartilage, Articular; Chondroitin Sulfates; Chromatography, High Pressure Liquid; Dermatan Sulfate; Female; Glycosaminoglycans; Heparitin Sulfate; Humans; Hyaluronic Acid; Keratan Sulfate; Male; Middle Aged; Osteoarthritis; Temporomandibular Joint; Temporomandibular Joint Disorders

Temporomandibular joint (TMJ) synovial fluid was aspirated from normal control subjects and patients undergoing surgery for TMJ dysfunction. The glycosaminoglycan (GAG) composition of this fluid was analysed and compared with the clinical diagnosis and histological appearance of the condylar tissues. Changes in GAG composition were observed where a histologically hyperplastic response was seen in joint tissues, but these findings did not necessarily correlate with the initial clinical diagnosis. It is suggested that the fluid composition reflects the current metabolic activities of the tissues and may provide a useful marker of such processes.

Topics: Adult; Chondroitin Sulfates; Female; Glycosaminoglycans; Humans; Hyaluronic Acid; Hyperplasia; Male; Mandibular Condyle; Middle Aged; Osteoarthritis; Pilot Projects; Synovial Fluid; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome