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

描述（由申请人提供）：颞下颌肌和关节疾病（TMJD）是具有重大公共卫生负担的常见疾病。虽然TMJD患者通常有颞下颌关节（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。最近完成的颞下颌疾病研究诊断标准（RDC/TMD）验证项目（U01 DEO13331）表明，1)TMJ成像需要诊断TMJ关节内疾病；2)横断面资料显示影像学诊断的DD和OA与颌骨疼痛、颌骨功能限制和残疾显著相关。因此，纵向评估这些横断面研究结果是否能够得到支持是至关重要的。鉴于现有的验证项目队列的成本为820万美元，未来不太可能有另一个类似的队列来调查这个对公共卫生具有重要意义的问题：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局有因果关系？研究参与者将在初始综合检查完成9年后从验证项目队列中召回。他们的身体状况将被重新评估，并通过比较双侧TMJ MRI和CT随访基线成像来测量关节内关节诊断的进展。受试者的社会心理状态也将被重新评估，疼痛强度、颌骨功能限制和残疾等主要结果指标是临床试验方法、测量和疼痛评估倡议（impact）推荐评估的核心领域。该研究将评估何时以及在何种情况下，关节内疾病进展，以及这种进展是否与颌骨疼痛、颌骨限制和残疾增加有关。作为次要目的，我们还将确定哪些基线生物学和社会心理因素是随访时TMJ DD和OA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，确定关节内疾病的进行性变化对疼痛和功能障碍结果的影响程度。该项目将为制定TMJD诊断和管理的循证指南提供必要的知识，并有助于经济有效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.