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

描述(由申请人提供)：颞下颌肌和关节紊乱病(TMJD)是一种常见的疾病，给公众健康造成了巨大的负担。尽管TMJD患者通常有关节内疾病，包括关节盘移位(DD)和骨关节炎(OA)，但这些疾病的临床意义及其与持续性颌痛和功能障碍的因果关系尚不清楚。最近完成的颞颌关节紊乱研究诊断标准(RDC/TMD)验证项目(U01 DEO13331)表明，1)TMJ成像是诊断TMJ关节内疾病所必需的；2)横断面数据显示，经放射学诊断的DD和OA与颌痛、颌骨功能受限和残疾显著相关。因此，我们必须纵向评估这些横向研究结果是否能得到支持，这一点至关重要。鉴于现有的验证项目队列是以820万美元的成本组装起来的，未来不太可能再有另一个类似的队列来研究这个对公共健康具有重大意义的问题：TMJ关节内疾病是否与患者报告的颌骨疼痛强度、颌骨功能和残疾的结果有关？研究参与者将在初步全面检查完成9年后从验证项目队列中被召回。他们的身体状况将被重新评估，他们关节内诊断的进展将通过比较基线成像的双侧TMJ MRI和CT来衡量。受试者的心理社会状况也将与疼痛强度、颌骨功能限制和残疾等主要结果指标一起重新评估，这些指标是临床试验中的方法、测量和疼痛评估倡议(IMMPACT)推荐进行评估的核心领域。这项研究将评估关节内疾病在什么时候和什么情况下进展，以及这种进展是否与颌痛、颌骨受限和残疾增加有关。我们还将确定，作为次要目标，哪些基线生物和心理社会因素是TMJ DD和OA在随访中进展的预测因素。最终目标是在生物心理社会模型的背景下，确定关节内疾病的渐进性改变对疼痛和功能障碍结果的贡献程度。该项目将为制定TMJD诊断和治疗的循证指南提供必要的知识，并有助于进行具有成本效益的成像和消除不必要的诊断辐射。

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.