Steenks Michel H, Giancane Gabriella, de Leeuw Rob R J, Bronkhorst Ewald M, van Es Robert J J, Koole Ron, van Bruggen H Willemijn, Wulffraat Nico M
Department of Oral and Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Oral Function and Prosthetic Dentistry, College of Dental Science, Radboud university nijmegen medical center, Nijmegen, The Netherlands.
Pediatr Rheumatol Online J. 2015 May 7;13:15. doi: 10.1186/s12969-015-0011-2.
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.
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.
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.
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).
在幼年特发性关节炎（JIA）中，颞下颌关节（TMJ）可能受累，导致下颌骨及相关结构疼痛、功能障碍和生长紊乱。三分钟筛查方案可能有助于风湿科医生系统地检测颞下颌关节受累情况。我们对74例连续的JIA患者进行了颞下颌关节检查方案检测颞下颌关节合并症的可靠性和有效性评估。
比较了风湿科医生和参考检查者（RE）的评估结果，并以疾病活动度（JADAS-27）作为外部参考来确定颞下颌关节检查方案的有效性。
该方案的内部一致性为0.73（Cronbach's α）。风湿科医生与参考检查者之间的检查者间一致性在0.25至0.87之间（Cohen's Kappa）。以JADAS“3.8”表示最小疾病活动度时，敏感性和特异性分别为0.57和0.77。曲线下面积（AUC）为0.70。发现两个阳性项目的临界值是选择可能有颞下颌关节受累患者的最佳阈值。
该方案在日常临床实践中可行。可靠性和有效性方面令人满意。颞下颌关节受累的筛查方案为风湿科医生提供了与JIA疾病活动度（JADAS-27）相关的系统且有针对性的颞下颌关节信息。
