title: Reliability of clinical symptoms in diagnosing temporomandibular joint arthritis in juvenile idiopathic arthritis.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI. koos-b@kfo-zmk.uni-kiel.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Koos
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
authors.forename: Marinka
authors.initials: M
authors.lastname: Twilt
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
authors.forename: Ullrike
authors.initials: U
authors.lastname: Kyank
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
authors.forename: Helge
authors.initials: H
authors.lastname: Fischer-Brandies
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
authors.forename: Volker
authors.initials: V
authors.lastname: Gassling
authors.affiliation: From the Department of Orthodontics, and the Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein, Kiel, Germany; Hospital for Sick Children, University of Toronto, Division of Rheumatology, Toronto, Ontario, Canada; University Medical Center, Children's Hospital, Rostock; Pediatric Rheumatology Research Institute (PRI), Bad Bramstedt, Germany.B. Koos, DMD, Department of Orthodontics, University Medical Center Schleswig-Holstein; M. Twilt, MD, PhD, Hospital for Sick Children, University of Toronto, Division of Rheumatology; U. Kyank, MD, University Medical Center, Children's Hospital; H. Fischer-Brandies, DMD, PhD, Department of Orthodontics, University Medical Center Schleswig-Holstein; V. Gassling, MD, DMD, Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein; N. Tzaribachev, MD, PRI.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Tzaribachev
mesh_terms: D001168:Arthritis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D001171:Arthritis, Juvenile / Q000150:complications* / Q000473:pathology; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010808:Physical Examination; D015203:Reproducibility of Results; D013704:Temporomandibular Joint / Q000473:pathology*; D013705:Temporomandibular Joint Disorders / Q000150:complications / Q000175:diagnosis* / Q000473:pathology
keywords: CLINICAL SYMPTOMS; JUVENILE IDIOPATHIC ARTHRITIS; MAGNETIC RESONANCE IMAGING; TEMPOROMANDIBULAR JOINT; TEMPOROMANDIBULAR JOINT ARTHRITIS