Thirty patients with symptomatic TMJ dysfunction and clinical and imaging evidence of internal derangements of the TMJ were evaluated. Before entering the superior joint space with the
arthroscope, 2 mL sterile saline was injected and, after 30 seconds of equilibration, was aspirated for analysis. The surgeon then performed diagnostic arthroscopy. The degree of
synovitis, degeneration, percent condylar roofing, and any pathologic changes, such as perforations, were recorded. The level of total
protein in each sample was ascertained, as well as the levels of
IL-1 beta,
IL-6, and
TNF-alpha.
RESULTS: Of 30 samples tested, three were discarded because of failure to gain access into the superior joint space. Of the 27 remaining samples,
IL-6 showed the closest correlation with the level of acute
synovitis demonstrated arthroscopically. Two of the higher
IL-6 levels (167 and 324 pg/microg
protein) were seen with patients with a significant disc perforation. In patients with a high degree of vascularity,
IL-6 was found to be between 0 to 581 pg/microg
protein with an average of 80 pg/microg
protein and a median value of 43 pg/mg. These values significantly correlated with the degree of vascularity (P < or = .02). This is in comparison with the 10 remaining patients, who showed significantly fewer vascular changes arthroscopically. In these patients, the range of
IL-6 was 0 to 35 pg/microg
protein, with an average of 19 pg/microg
protein and a median value of 14.5 pg/microg. These values significantly correlated with the smaller degree of vascularity (P < or = .02). In seven patients, the role of nonsteroidal antiinflammatory
drug (
NSAID) use resulted in decreased levels of
IL-6, which has been noted in previous studies. In patients with higher rated redundancy of the synovial tissue, the average
IL-6 level was 92 pg/microg
protein, whereas the median value was 44 pg/microg
protein. In patients with little or no redundant synovial tissue, an average
IL-6 level of 22 pg/microg
protein was present. The median value in these same joints was 15 pg/microg
protein. These
IL-6 values significantly correlated with the degree of redundancy (P < or = .03). The degree of degenerative change (
chondromalacia, fibrillation), disc displacement (roofing), and the presence or absence of adhesions did not significantly affect the levels of
IL-6 within the patients studied. The presence of
IL-1 beta and
TNF-alpha was not found to correlate with the arthroscopic findings in the superior joint space.
CONCLUSIONS: