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The aim of this study was to evaluate whether an increased capsular width evidenced by ultrasound (US) could be an indirect marker of temporomandibular joint (TMJ) effusion. 138 TMJs were evaluated by US and magnetic resonance imaging (MRI) by two blinded calibrated investigators. US measures of capsular width (in mm) and MRI diagnosis of TMJ effusion (presence/absence) were used to perform a receiver operating characteristic (ROC) curve analysis in order to assess the most accurate cut-off value of capsular width that was able to discriminate between joints with and without MRI effusion. Diagnostic accuracy of US to detect MRI-depicted TMJ effusion was good (area under the ROC curve = 0.8 17). US sensitivity was high for values below the cut-off value of 1.950mm (true positive rate (TPR) = 83.9%; false positive rate (FPR) = 26.3%). while specificity was high for values above the cut-off value of 2.150mm (TPR = 71.0%; FPR = 11.8%). Analysis of ROC curve appears to reveal that the critical area is around the 2 mm value for TMJ capsular width. These findings need to be refined by further studies assessing the smallest detectable difference in capsular width, with attention to reliability of interobserver observations. [ABSTRACT FROM AUTHOR]

The authors revised the recent literature mainly concerning the diagnostic criteria of Sjögren's syndrome (SS). There is no agreement between different authors on this matter: this makes an exact diagnosis of primary and secondary SS difficult. This difficulty is related to the epidemiological studies and other researches, as readers do not clearly understand if, following different criteria, the authors are examining the same disease or different diseases. For instance, it is difficult to make the distinction between rheumatoid arthritis with SS and primary SS with an overt arthropathy. The same thing happens for associated connective tissue diseases or fibromyalgia. It is also not jet clear if 'sicca syndrome' is either the beginning of a true SS or a separate clinical entity with etiopathogenetic, clinical and prognostic characteristics differing from those of SS. The authors, also on the basis of their studies, try to clarify the matter. These difficulties are less in the clinical setting where the diagnosis is made for each patient on the basis of the clinical experience of the physician. [ABSTRACT FROM AUTHOR]