Anesthesia/facial pain
Association Between Polymorphisms in the Genes of Estrogen Receptors and the Presence of Temporomandibular Disorders and Chronic Arthralgia

https://doi.org/10.1016/j.joms.2017.10.023Get rights and content

Purpose

The high prevalence of painful temporomandibular disorders (TMDs) in women suggests that estrogen and its receptors play a fundamental etiologic role in the development of this joint pathology through complex action mechanisms. The aim of this study was to evaluate the possible association between polymorphisms in the ESR1 (estrogen receptor-1) and ESRRB (estrogen-related receptor-β) genes and the risk of simultaneous development of TMDs and pain in other joints in the body.

Materials and Methods

All participants were clinically evaluated for the presence of TMD (Research Diagnostic Criteria for TMD) and asked about the presence of chronic joint pain. The control group consisted of 72 patients without TMD and without pain. Participants with arthralgia were divided into 3 groups: with muscular TMD (n = 42), with articular TMD (n = 16), and without TMD and with systemic arthralgia (n = 82). Eight single-nucleotide polymorphisms in the ESR1 (rs12154178, rs1884051, rs2273206, rs7774230) and ESRRB (rs1676303, rs4903399, rs10132091, rs7151924) genes were investigated. The χ2 test and Student t and Mann-Whitney tests were used to assess the relevance of nominal and continuous variables, respectively. A P value less than .05 was considered significant.

Results

The TT (timin/timin) genotype for the ESR1 (rs2273206) gene was strongly associated with the risk of developing muscle TMDs and temporomandibular joint pain (P = .04). For the ESRRB (rs1676303) gene, an association was observed between the CC (cytosine/cytosine) genotype and the presence of articular TMDs associated with other chronic arthralgia (P = .02). These results were confirmed by the increased risk of developing articular TMDs associated with the C allele (P = .04).

Conclusions

This study supports the hypothesis that changes in the ESR1 and ESRRB genes influence the presence of TMDs associated with chronic joint pain.

Section snippets

Materials and Methods

This is a descriptive cross-sectional randomized study that was approved on May 30, 2013 by the research ethics committee of the Salgado de Oliveira University (Niterói, RJ, Brazil; opinion number 286.354). Free and informed consent was obtained from participants in writing before conducting the research. Recommendations from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)27 statement were followed for the design and development of this study.

Study subjects

Clinical Findings: Prevalence of TMD and Other Arthralgia

Of 337 volunteers evaluated during a 2-year period, 212 were included in the study. Of these, 58 (32 women [55.2%] and 26 men [44.8%]) had TMDs and other arthralgia. Of the TMD subgroups, 42 (33%) had only muscular disorders and 16 (12.5%) had only joint disorders. The group without TMD but with other chronic joint pain (n = 82) was composed of 52 women (63.4%) and 30 men (36.6%). The control group was composed of 72 participants (39 women [54.2%] and 33 men [45.8%]) without articular symptoms

Discussion

The function of estrogen in the development and perpetuation of chronic pain based on genomic mechanisms (determined by their interaction with nuclear ER-α and ER-β) and non-genomic mechanisms (involving G protein-coupled receptors)4 has been extensively explored. However, the high prevalence of osteoarthritis in postmenopausal women raised interest in how such receptors might act not only in the perception and processing of painful stimuli33 but also in the homeostasis of articular tissues.34

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    Financial support of this work was provided by the School of Medicine of Petrópolis.

    Conflict of Interest Disclosures: None of the authors have a relevant financial relationship(s) with a commercial interest.

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