Effectiveness of manual therapy applications in individuals with romatoid arthritis who have temporomandibular joint dysfunction

This study was conducted to investigate the effect of manual therapy applications on pain, range of motion and joint position sense in individuals with rheumatoid arthritis who have temporomandibular joint dysfunction. The 57 patients included in the study were divided into 3 groups by simple randomization. Group 1 received myofascial mobilization of masticatory muscles and group 2 received temporomandibular joint mobilization twice a week for 6 weeks. The control group received no treatment. The groups were evaluated twice, before and after treatment. The control group underwent a second evaluation 6 weeks after the first evaluation. C-ROM was used to evaluate cervical range of motion and joint position sensation, millimeter ruler was used to evaluate TMJ range of motion, Algometer was used to evaluate pressure pain threshold of muscles, Headache Impact Test-HIT-6 was used for headache, Fonseca Anamnestic Index (FAI) and Jaw Function Limitation Scale-20 (JFLS-20) were used for temporomandibular dysfunction severity, Generalized Anxiety Disorder-7 (GAD-7) was used for emotional state. In the assessment of cervical range of motion, only the right lateral flexion angle demonstrated a significant pre–post increase in the control group (p<0.05). In the soft tissue mobilization group, significant increases were observed in flexion and rotation angles, while significant decreases were detected in flexion and extension deviation measures (p<0.05). In the joint mobilization group, flexion, extension, lateral flexion, and rotation angles significantly increased, whereas deviation measures significantly decreased (p<0.05). Between-group comparisons showed that left lateral flexion angle and left lateral flexion deviation were significantly improved only in the joint mobilization group, while right rotation angle significantly improved in both intervention groups (p<0.05). Notably, soft tissue mobilization yielded a greater increase in right rotation compared with joint mobilization. In pressure pain threshold (PPT) assessment, significant post-treatment increases were found across all sites in both soft tissue and joint mobilization groups (p<0.05), whereas the control group showed a significant decrease only in the left TMJ lateral measurement (p<0.05). Between-group analyses revealed significant differences in favor of soft tissue mobilization for the right masseter, left anterior temporalis, and left masseter (p<0.05), and in favor of joint mobilization for the right TMJ lateral and left anterior temporalis (p<0.05). No significant differences were observed between the two treatment groups (p>0.05). In mandibular range of motion, all measures improved significantly after treatment in both mobilization groups (p<0.05), whereas the control group showed significant decreases in depression and protrusion (p<0.05). Between-group comparisons indicated a significant difference only in retrusion between soft tissue mobilization and the control group (p<0.05). Regarding patient-reported outcomes, the soft tissue mobilization group demonstrated significant post-treatment reductions in GAD-7, Fonseca, JFLS-20 Chewing, JFLS-20 Mobility, and JFLS-20 Total scores (p<0.05). Similar improvements were observed in the joint mobilization group (p<0.05). In contrast, the control group showed significant increases in GAD-7, Fonseca, and JFLS-20 subscores (p<0.05). Between-group comparisons revealed significant differences between soft tissue mobilization and the control group for Fonseca, JFLS-20 Chewing, and JFLS-20 Total (p<0.05), with improvements in the intervention group and deterioration in controls. Comparisons of joint mobilization and control groups showed significant differences in HIT-6, Fonseca, and JFLS-20 subscores (p<0.05), again reflecting improvements in the intervention group and worsening in controls. Overall, in individuals with rheumatoid arthritis and temporomandibular joint dysfunction, both soft tissue and joint mobilization significantly reduced pain, functional limitations, anxiety, and improved joint mobility. While both interventions contributed to symptom relief, several parameters deteriorated in the control group. These findings suggest that manual therapy techniques may represent an effective treatment option for TMJ dysfunction in RA patients.