PT  - JOURNAL ARTICLE
AU  - Bernd Koos
AU  - Marinka Twilt
AU  - Ullrike Kyank
AU  - Helge Fischer-Brandies
AU  - Volker Gassling
AU  - Nikolay Tzaribachev
TI  - Reliability of Clinical Symptoms in Diagnosing Temporomandibular Joint Arthritis in Juvenile Idiopathic Arthritis
AID  - 10.3899/jrheum.131337
DP  - 2014 Sep 01
TA  - The Journal of Rheumatology
PG  - 1871--1877
VI  - 41
IP  - 9
4099  - http://www.jrheum.org/content/41/9/1871.short
4100  - http://www.jrheum.org/content/41/9/1871.full
SO  - J Rheumatol2014 Sep 01; 41
AB  - Objective. Temporomandibular joint (TMJ) arthritis, commonly considered oligoarthritic/asymptomatic, occurs frequently in children with juvenile idiopathic arthritis (JIA), and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) has proved to be a sensitive diagnostic tool in this context. We compared the reliability of clinical examinations to Gd-MRI results in diagnosing the condition. Methods. Patients with JIA (134 consecutive) underwent routine clinical and Gd-MRI examinations. The clinical items examined were clicking, tenderness (TMJ/adjacent muscles), and mouth-opening capacity. Blinded MRI reading focused on inflammation (synovitis/hypertrophy). After statistical power analysis, the clinical findings for 134 healthy controls were included. Contingency analysis was used to determine the sensitivity, specificity, and frequency of clinical symptoms (JIA/healthy controls); Cohen’s κ was used to establish the interrater reliability. Results. Statistically significant differences were observed between JIA and healthy control groups with regard to the concise screening items (power analysis > 0.95), whereas no differences in mouth-opening capacity were noted. In 80% of the patients with JIA, Gd-MRI revealed signs of TMJ arthritis, with positive correlations between concise screening items and Gd-MRI results. The average specificity was 0.81, but the sensitivity was low, at 0.42. Combining items led to a marked increase in the sensitivity (0.73). There was a high rate of both false-negative and false-positive results (corresponding to clinical underdiagnosis or overdiagnosis of TMJ arthritis). Conclusion. Despite a relatively high specificity, clinical examination alone does not seem sufficiently sensitive to adequately detect TMJ arthritis. Thus, a relatively high number of cases will be missed or overdiagnosed, potentially leading to undertreatment or overtreatment. Gd-MRI may support correct diagnosis, thereby helping to prevent undertreatment or overtreatment.