Temporomandibular joint damage in juvenile idiopathic arthritis: Diagnostic validity of diagnostic criteria for temporomandibular disorders

Abstract

Summary Background Diagnostic criteria reported in the expanded taxonomy for temporomandibular disorders include a standardised clinical examination and diagnosis (DC/TMD 3.B) of temporomandibular joint (TMJ) damage in patients with juvenile idiopathic arthritis (JIA); however, their validity is unknown. Objectives To assess the validity of DC/TMD 3.B for the identification of TMJ damage in JIA‐patients, using magnetic resonance imaging (MRI) as gold standard, and to investigate the relation between clinical findings and TMJ damage. Methods Fifty consecutive JIA patients (9‐16 years) were recruited. DC/TMD 3.B were compared with TMJs MRI (100 TMJs) performed maximum at 1 month from the visit. The severity of TMJ damage was scored in four grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), logistic regression models with odds ratio of DC/TMD 3.B and clinical findings respect to MRI were calculated. Results The DC/TMD 3.B were inadequate in the identification of TMJ damage (sensitivity = 0.15, specificity = 0.92, PPV = 0.85, NPV = 0.28, P = 0.350). Chin deviation and TMJ crepitus were associated with worse TMJ damage (P = 0.006; P = 0.034). Reduced mouth opening (OR = 3.91, P = 0.039) and chin deviation (OR = 13.7, P = 0.014) were associated with the presence of TMJ damage. Combining “pain” (history of pain, TMJ pain, pain during movements) and “function” (TMJ crepitus, reduced mouth opening, chin deviation) clinical findings, the sensitivity and the specificity were 0.88 and 0.54. Conclusion DC/TMD 3.B present a low sensitivity to diagnose TMJ damage. Chin deviation, reduced mouth opening and TMJ crepitus are associated with TMJ damage. We suggest combining “pain” and “function” findings for the evaluation of TMJ damage in JIA patients.

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross- sectional multicentre study

“…Moreover, TMJ-related clinical signs and vertical unassisted jaw movement ≤40 mm had the highest association in the JIA group. The reported prevalence of TMD in children with JIA varies between 38 and 83% according to the definitions and methods of ascertainment used, to the cohort examined, and to differences in populations [15,[24][25][26][27]. Ferraz and colleagues, in their study of 15 children with JIA ranging in age from 6 to 28 years (mean age 16.3 years), reported a high prevalence of 83%.…”

Prevalence of temporomandibular disorder in children and adolescents with juvenile idiopathic arthritis – a Norwegian cross-sectional multicentre study

“…The reported prevalence of TMD in children with JIA varies between 38% and 83% according to the de nitions and methods of ascertainment used, to the cohort examined, and to differences in populations (15,(32)(33)(34)(35). Ferraz and colleagues, in their study of 15 children with JIA ranging in age from 6 to 28 years (mean age 16.3 years), reported a high prevalence of 83%.…”

“…Still, they did not describe the method of ascertainment, i.e., whether the gures were based on self-reporting or on clinical examination [28]. A previous study from Rongo and colleagues based on 50 participants with JIA aged 9-16 years found a prevalence of TMJ damage from 100 joints to be 74% as assessed by MRI [33]. Others have reported a prevalence of 55% based on a questionnaire [31] and of 72% based on clinical signs [32].…”

Effects on the Facial Growth of Rapid Palatal Expansion in Growing Patients Affected by Juvenile Idiopathic Arthritis with Monolateral Involvement of the Temporomandibular Joints: A Case-Control Study on Posteroanterior and Lateral Cephalograms

“…Patients were evaluated according to the International League of Associations for Rheumatology (ILAR) criteria (8 cases polyarticular JIA, 17 oligoarticular JIA). The mean age of JIA onset was 7.1 years of age [38,39].…”