Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis

Abstract

Objective To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for the temporomandibular joint (TMJ) (JAMRIS‐TMJ). Methods An adaptive partial‐profile, discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non‐radiologist clinicians to determine the group‐averaged relative weights for the JAMRIS‐TMJ. Subsequently, an image‐based vignette ranking exercise was done, during which experts individually rank ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS‐TMJ assessment criteria. Validity of the weighted JAMRIS‐TMJ was tested by comparing the consensus‐graded, DCE‐weighted JAMRIS‐TMJ score of the vignettes with their unrestricted image‐based ranks provided by the experts. Results Nineteen experts completed the DCE survey, and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed nonlinear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS‐TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's ρ of 0.92 (interquartile range [IQR] 0.87–0.95) for the inflammation and 0.93 (IQR 0.90–0.94) for the damage domain. Conclusion A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS‐TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus‐Based Recommendations

“…This recommendation specifies “active” TMJ inflammation to differentiate from TMJ involvement without active inflammation (Table 1 ) ( 15 ). The use of JIA‐specific TMJ MRI protocols and scoring systems is recommended ( 22 , 23 , 24 , 25 ). It is recognized that the interpretation of MRI findings has an element of subjectivity and is influenced by the technique and equipment used for image capture, as well as by the expertise of the reader.…”

Determination of Relative Weightings for Sacroiliac Joint Pathologies in the OMERACT Juvenile Arthritis Magnetic Resonance Imaging Sacroiliac Joint Score

“…Erosion was rated second in relative importance by expert preference among the JAMRIS-SIJ damage domain, having 1.8 times more importance than backfill and 1.3 times more importance compared to sclerosis. The differential weights of the measurement items in the JAMRIS-SIJ are similar to the MRI scoring system for temporomandibular joint in JIA [ 16 ].…”

Role of Ultrasound Evaluation of Temporomandibular Joint in Juvenile Idiopathic Arthritis: A Systematic Review

“…For example, unlike other authors, Weiss et al did not consider contrast enhancement as a sign of active inflammation. In this regard, efforts to develop a standardized TMJ-MRI scoring system are ongoing [ 20 , 51 , 52 ].…”

“…MRI cannot be frequently repeated, may need sedation, and is expensive. Furthermore, knowledge about the gadolinium-based contrast medium effects is growing and, besides the nonallergic and allergy-like reactions, additional complications such as brain deposition are nowadays a matter of concern [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”