title: Temporomandibular joint involvement in Juvenile Idiopathic Arthritis: reliability and validity of a screening protocol for the rheumatologist.
abstract: BACKGROUND
  In Juvenile Idiopathic Arthritis (JIA) the temporomandibular joint (TMJ) can be involved leading to pain, dysfunction and growth disturbances of the mandible and associated structures. There may be value to a three minute screening protocol allowing the rheumatologist to detect TMJ involvement systematically. Reliability and validity of the TMJ protocol for detecting TMJ co-morbidity were determined in 74 consecutive JIA patients.
  
  
  METHODS
  The assessments of the rheumatologist and of a reference examiner (RE) were compared and validity of the TMJ protocol was established using the disease activity (JADAS-27) as an external reference.
  
  
  RESULTS
  The internal consistency of the protocol was 0.73 (Cronbach's alpha). The inter-examiner agreement between the rheumatologist and the RE varied between 0.25 and 0.87 (Cohen's Kappa). Sensitivity and specificity, with the JADAS "3.8" indicating minimal disease activity, were 0.57 and 0.77 respectively. The area under the curve (AUC) was 0.70. A cut-off value of two positive items was found to be an optimal threshold to select the patients with likely TMJ involvement.
  
  
  CONCLUSIONS
  The use of the protocol is feasible in everyday clinical practice. Reliability and validity aspects were satisfactory. The screening protocol for TMJ involvement provides the rheumatologist with systematic and focused TMJ information which relates to the JIA disease activity (JADAS-27).
authors.affiliation: Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands. m.h.steenks@umcutrecht.nl.|Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud university nijmegen medical center, Nijmegen, The Netherlands. m.h.steenks@umcutrecht.nl.
authors.forename: Michel H
authors.initials: MH
authors.lastname: Steenks
authors.affiliation: Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. g.giancane@umcutrecht.nl.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Giancane
authors.affiliation: Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands. j.r.j.deleeuw@umcutrecht.nl.
authors.forename: Rob R J
authors.initials: RR
authors.lastname: de Leeuw
authors.affiliation: Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud university nijmegen medical center, Nijmegen, The Netherlands. ewald.bronkhorst@radboudumc.nl.
authors.forename: Ewald M
authors.initials: EM
authors.lastname: Bronkhorst
authors.affiliation: Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands. r.j.j.vanes@umcutrecht.nl.
authors.forename: Robert J J
authors.initials: RJ
authors.lastname: van Es
authors.affiliation: Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands. r.koole@umcutrecht.nl.
authors.forename: Ron
authors.initials: R
authors.lastname: Koole
authors.affiliation: Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands. willemijn.vanbruggen@radboudumc.nl.|Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud university nijmegen medical center, Nijmegen, The Netherlands. willemijn.vanbruggen@radboudumc.nl.
authors.forename: H Willemijn
authors.initials: HW
authors.lastname: van Bruggen
authors.affiliation: Pediatric Immunology, University Medical Center Utrecht, Utrecht, The Netherlands. n.wulffraat@umcutrecht.nl.
authors.forename: Nico M
authors.initials: NM
authors.lastname: Wulffraat
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D015588:Observer Variation; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D012219:Rheumatology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013284:Stomatognathic System / Q000503:physiopathology; D013704:Temporomandibular Joint / Q000503:physiopathology*