title: Clinical predictors of temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic literature review.
abstract: To assess the level of evidence for subjective and objective parameters in clinical orofacial examination and determine if predictors for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) patients exist in the current literature.
  
  
  
  A comprehensive systematic electronic search strategy was performed in all major medical databases in June 2015. Studies were selected independently by two reviewers in accordance with a prespecified protocol and a risk of bias assessment for all included studies. Subjective examination outcome measures assessed were pain, decreased TMJ function, and TMJ sounds. The objective outcome measures assessed were maximal incisor opening, mandibular asymmetric opening, condylar translation, protrusion, myofascial pain on palpation, facial asymmetry, and micro- or retrognathism.
  
  
  
  The electronic database search identified 345 unique citations. After application of our strict, predefined inclusion and exclusion criteria, 21 articles were included and data extracted. The study heterogeneity did not allow for meta-analyses. No singular outcome measure can be suggested as a predictor of TMJ involvement in JIA, as sensitivity and/or specificity is too low compared to contrast-enhanced magnetic resonance imaging.
  
  
  
  The current low level of evidence and study heterogeneity do not allow us to conclude on singular clinical outcome measures. To increase study comparability, we call for a standardized terminology and evidence-based guidelines for clinical orofacial examination parameters in JIA patients.
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C DK-8000, Denmark; Specialist Oral Health Center for Western Norway, Stavanger, Rogaland, Norway. Electronic address: kdki@odont.au.dk.
authors.forename: Kasper Dahl
authors.initials: KD
authors.lastname: Kristensen
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C DK-8000, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Stoustrup
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C DK-8000, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Annelise
authors.initials: A
authors.lastname: Küseler
authors.affiliation: Section of Orthodontics, Aarhus University, Vennelyst Boulevard 9, Aarhus C DK-8000, Denmark; Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Thomas Klit
authors.initials: TK
authors.lastname: Pedersen
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Marika
authors.initials: M
authors.lastname: Twilt
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Herlin
mesh_terms: D001171:Arthritis, Juvenile / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D010808:Physical Examination; D012307:Risk Factors; D013704:Temporomandibular Joint / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*
keywords: Clinical examination; Diagnosis; Juvenile idiopathic arthritis; Systematic review; Temporomandibular joint