TMJ Intra-Articular Disorders: Impact on Pain, Functioning and Disability

颞下颌关节内疾病：对疼痛、功能和残疾的影响

• 批准号: 8501415
• 负责人: ERIC L SCHIFFMAN
• 金额: $ 58.57万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-13 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8501415
• 关键词: Accounting; Address; Affect; Anxiety; Behavior; Benefits and Risks; Bilateral; Biological; Biological Factors; Chronic; Chronic low back pain; Clinical; Clinical Trials; Communities; Complex; Data; Degenerative polyarthritis; Development; Diagnosis; Diagnostic; Diagnostics Research; Disease; Disease Management; Employee Strikes; Functional disorder; Future; Goals; Guidelines; Image; Investigation; Jaw; Joints; Knowledge; Magnetic Resonance Imaging; Measurement; Measures; Mental Depression; Methods; Modeling; Muscle; Musculoskeletal; Myalgia; Myopathy; Operative Surgical Procedures; Oral; Outcome; Outcome Measure; Outcome Study; Pain; Pain Measurement; Pain intensity; Participant; Pathology; Patient Care; Patient Outcomes Assessments; Patients; Population; Psychosocial Assessment and Care; Psychosocial Factor; Public Health; Radiation; Relative (related person); Research Personnel; Resolution; Signs and Symptoms; Sleep; Stress; Structure of articular disc of temporomandibular joint; Symptoms; Temporomandibular Joint; Temporomandibular Joint Disorders; Testing; Time; Treatment Cost; Validation; arthropathies; base; biopsychosocial; care seeking; clinically significant; cohort; cost; cost effective; disability; evidence based guidelines; follow-up; health care service utilization; health related quality of life; imaging modality; pressure; primary outcome; psychosocial

DESCRIPTION (provided by applicant): Temporomandibular muscle and joint disorders (TMJD) are common conditions with a substantial public health burden. Although TMJD patients commonly have temporomandibular joint (TMJ) intra- articular disorders, including disc displacement (DD) and osteoarthritis (OA), the clinical significance of these disorders and their causal relationship to persistent jaw pain and dysfunction are poorly understood. The recently completed Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) Validation Project (U01 DEO13331) demonstrated that 1) TMJ imaging is required to diagnose TMJ intra-articular disorders; and 2) cross-sectional data show that radiographically diagnosed DD and OA are significantly associated with jaw pain, jaw functional limitations and disability. It is therefore critical that we assess longitudinally whether these cross-sectional findings can be supported. Given that the available Validation Project cohort was assembled at a cost of $8.2 million, it is unlikely that there will be another similar cohort in the future to investigate the question, one of great significance to the public health: Are TMJ intra-articular disorders causally related to patient-reported outcomes of jaw pain intensity, jaw function and disability? Study participants will be recalled from the Validation Project cohort 9 years after their initial comprehensive examination was completed. Their physical status will be re-assessed, and progression of their intra-articular joint diagnoses will be measured by comparing bilateral TMJ MRI and CT at follow-up to baseline imaging. The subjects' psychosocial status will also be re-assessed along with the primary outcome measures of pain intensity, jaw functional limitations, and disability that are core domains recommended for assessment by Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT). The study will assess when, and under what circumstances, intra-articular disorders progress and whether this progression is associated with increased jaw pain, jaw limitations and disability. We will also determine, as a secondary aim, which baseline biological and psychosocial factors are predictors for progression of TMJ DD and OA at follow-up. The ultimate goal is to determine the degree to which progressive change in intra-articular disorders contributes to pain and dysfunction outcomes, within the context of the biopsychosocial model. This project will provide knowledge necessary for development of evidence-based guidelines for TMJD diagnosis and management, as well as contribute to cost effective imaging and elimination of unnecessary diagnostic radiation.

描述（由申请人提供）：颞下颌肌肉和关节疾病（TMJD）是一种常见疾病，给公共卫生造成了巨大负担。虽然TMJD患者通常患有颞下颌关节（TMJ）关节内疾病，包括椎间盘移位（DD）和骨关节炎（OA），但这些疾病的临床意义及其与持续性颌骨疼痛和功能障碍的因果关系尚不清楚。最近完成的颞下颌关节紊乱病研究诊断标准（RDC/TMD）验证项目（U 01 DEO 13331）证明：1）TMJ成像需要诊断TMJ关节内紊乱; 2）横断面数据显示，X线诊断的DD和OA与颌骨疼痛、颌骨功能限制和残疾显著相关。因此，我们纵向评估这些横断面调查结果是否得到支持至关重要。鉴于现有的验证项目队列是以820万美元的成本组装的，未来不太可能有另一个类似的队列来研究这个问题，这对公共卫生具有重要意义：TMJ关节内疾病是否与患者报告的下颌疼痛强度，下颌功能和残疾的结果有因果关系？研究参与者将在完成初步全面检查后9年从验证项目队列中召回。将重新评估他们的身体状况，并通过比较随访时的双侧TMJ MRI和CT与基线成像来测量关节内关节诊断的进展。还将沿着疼痛强度、颌功能限制和残疾的主要结局指标重新评估受试者的心理社会状态，这些指标是临床试验方法、测量和疼痛评估倡议（IMMPACT）建议进行评估的核心领域。该研究将评估关节内疾病进展的时间和情况，以及这种进展是否与下颌疼痛增加，下颌限制和残疾有关。作为次要目的，我们还将确定哪些基线生物学和心理社会因素是随访时TMJ DD和OA进展的预测因子。最终目标是在生物心理社会模型的背景下，确定关节内疾病的进行性变化对疼痛和功能障碍结局的影响程度。该项目将提供必要的知识，为TMJD诊断和管理的循证指南的发展，以及有助于成本效益的成像和消除不必要的诊断辐射。