Temporomandibular joint involvement in Juvenile Idiopathic Arthritis: reliability and validity of a screening protocol for the rheumatologist.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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).

Opinions of patients with type 2 diabetes about responsibility, setting targets and willingness to take medication. A cross-sectional survey.

OBJECTIVE: To assess opinions and their determinants of patients with type 2 diabetes about responsibility for managing their diabetes, setting treatment targets and willingness taking medication. METHODS: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES: opinions about responsibility, targets and medication. Multinomial logistic regression analysis. RESULTS: Data of 994 consecutive persons were analysed (mean age 65 years; 54% males). Of these 62% agreed to take responsibility for their diabetes. In the opinion of 89% the setting of targets should be by or in cooperation with their physician or nurse and 40% were willing to take tablets until all targets were attained. Patients who perceived dysfunction by barriers to activity did not agree to take responsibility (OR 3.68; 1.65-8.19). Patients with complications preferred to set targets in cooperation with their physician or nurse (OR 1.98; 1.03-3.80). Males were more willing to take tablets until all targets were attained (OR 1.62; 1.17-2.25). CONCLUSION: Not all patients want to take responsibility for their diabetes or taking all necessary tablets, especially those with barriers to activity or complications. PRACTICE IMPLICATIONS: Doctors and nurses should ask for patients' opinions about responsibility and treatment goals before starting education.