全身性エリテマトーデスにおける側頭顎関節の無菌性壊死

[Aseptic necrosis of the temporomandibular joint in systemic lupus erythematosus].

• V M Grinin
• Iu M Maksimovskiĭ
• V A Nasonova

抄録

全身性エリテマトーデス（SLE）と診断された285名の患者を診察した。これらの患者は、側頭顎関節（TMJ）の痛みや下顎の可動性の制限を訴えていた。顎関節の慢性関節炎と下顎枝の短縮（3-4mm）を認めた患者が8人いた。25～38歳の女性患者4名には、約5.5年持続するSLEで、顎関節の筋関節機能障害の片側性徴候、浸食や破壊を伴わない関節頭部の扁平化と減少、内部輪郭が不均一な皮質下丸い病巣が頭部中央部または中央部に認められ、病巣の上の骨が薄くなり、関節表面が扁平化していました；これらの変化は関節の血管壊死（AN）と考えられました。下顎枝の短縮は、関節突起の頸部の変形と後方への偏位が原因であった。顎関節の変化は他の関節には見られませんでした。これら4人のSLEと顎関節症の患者はすべててんかん発作を伴う脳症（2人に多くみられた）、Raynaud症候群、手のひらと足の裏の明るい毛細血管を呈し、2人は抗リン脂質症候群の臨床像を呈していた。コンピュータ断層撮影と磁気共鳴所見で顎関節症の発症を確認した。

A total of 285 patients with verified systemic lupus erythematosus (SLE) were examined. They complained of painful temporo-mandibular joint (TMJ) and/or limited mobility of the mandible. Eight patients with chronic arthritis of the TMJ and a shortened (by 3-4 mm) mandibular branch were detected. In 4 female patients aged 25-38 with SLE lasting for about 5.5 years, unilateral signs of myoarticular dysfunction of the TMJ, flattening and decrease of the articular head without erosion and destruction, subcortical round foci with uneven internal contours were found in the central or median part of the head, with the compact bone above the foci thinned and the articular surface flattened; this prompted us to regard these changes as avascular necrosis (AN) of the joint. Shortening of the mandibular branch was caused by deformation of the neck of the articular process and its declination backwards. The detected changes in the TMJ were not accompanied by involvement of other joints. All these 4 patients with SLE and TMJ AN suffered from cerebropathy with epileptic attacks (frequent in 2 patients), Raynaud's syndrome, and bright capillaries of the palms and soles; 2 patients developed clinical picture of the antiphospholipid syndrome. Computer tomography and magnetic resonance findings validating the development of TMJ AN in?