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A recent article posted to the Musculoskeletal Network, written by Anne Grete Semb MD, PhD, reviews some facts related to carotid plaques and rheumatoid arthritis. While this is topic is not of specific interest to dentists, one of the five things that it is suggested ‘to know” (Semb AG, Rollefstad S, Provan SA et al. Carotid Plaque Characteristics and Disease Activity in Rheumatoid Arthritis. J Rheumatol (2013) 40:4-10) relates to the relative risk of atherosclerotic plaques in RA patients. Why this is important to dentists is that jaw and TMJ pain can be caused by carotid inflammation associated with these plaques and this pain may be misdiagnosed as of dental origin.

Dr Semb reports that recent evidence suggests that patients with rheumatoid arthritis (RA) have twice as many atherosclerotic plaques in their carotid arteries as do people unaffected by RA. She cites a specific study involving 152 RA patients and 89 controls that “has shown that plaques were more numerous in RA patients and also more likely to be present bilaterally”.

In another comparative controlled sonography study localizing these plaques, the results appear to show that intima media thickness in the proximal internal carotid artery is significantly greater among RA patients than among controls (Kobayashi H, Giles JT, Polak JF et al. Increased Prevalence of Carotid Artery Atherosclerosis in Rheumatoid Arthritis Is Artery-specific. J Rheumatol (2010) 37:3).

Another interesting point that is made in the article is that autopsy studies suggest that in RA patients the coronary artery plaques may be more inflammatory and unstable but less atherosclerotic than controls who do not have RA. And when assessed by the Clinical Disease Activity index, carotid plaques were found to be more vulnerable to rupture (Semb AG, Rollefstad S,. Provan SA et al. Carotid Plaque Characteristics and Disease Activity in Rheumatoid Arthritis. J Rheumatol (2013) 40:4-10).

Carotid inflammation associated with plaques may be associated with pain referred to the jaw, TMJ, and ear region. The quality of this pain is described in medical texts as typically a mild to moderate ache or throb that is aggravated by palpation of the carotid artery. Pain may be unilateral or bilateral and can last from a few days to weeks. A chronic form is also described. (Aydil U, Kizil Y, Köybaşioğlu A.Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders. Eur Arch Otorhinolaryngol. 2012 Jan;269(1):9-16)(Murray TJ. Carotidynia: a cause of neck and face pain. Can Med Assoc J. 1979 Feb 17;120(4):441-3).Carotidynia is typically aggravated by swallowing or chewing which may bring the RA patient into the dental office for evaluation. If a dental cause of the pain is ruled out by physical and radiologic examination, then the patient should be referred for additional evaluation to rule out carotid pathology.