Spoorenberg A, van der Heijde D, Dougados M, de Vlam K, Mielants H, van de Tempel H, van der Linden S
University Hospital Maastricht, Maastricht, The Netherlands.
Ann Rheum Dis. 2002 Sep;61(9):799-803. doi: 10.1136/ard.61.9.799.
To determine the reliability of self reported joint counts to assess pain or swelling in ankylosing spondylitis (AS).
217 outpatients fulfilling the modified New York criteria for AS were asked to mark painful joints and swollen joints on two mannequins presenting 44 and 40 joints respectively. A doctor or research nurse assessed the same joints for pain and swelling on the same day, after completion by the patient, without information on the results of the patient's assessment.
Forty six (21%) patients reported one or more swollen joints (mean number of swollen joints 0.5, range 0-8); the doctor found one or more swollen joints in 54 (25%) of the patients (mean number of swollen joints 0.8, range 0-31). The overall agreement on the number of swollen joints between patients and doctor was moderate (intraclass correlation coefficient (ICC) 0.53). Agreement on individual swollen joints was poor to moderate (kappa 0.1-0.64). 128 (60%) patients reported tender joints (mean number of joints 2.4, range 0-26). The doctors reported one of more tender joints in 50% of the patients (mean number of tender joints 2.2, range 0-34). The overall agreement was also moderate (ICC 0.71). The agreement on individual tender joints was again poor to moderate (kappa 0.19-0.43). There was only high concordance between doctors and patients on the absence of swollen joints (82%). The concordance on the presence of monoarthritis, oligoarthritis, or polyarthritis was low (17-22%).
Owing to these discrepancies in assessment of individual joints and total number of affected joints, joint counts in AS assessed by doctors cannot be replaced by joint counts reported by the patients. Patients are only able to judge if their joints are not swollen.
确定自我报告的关节计数在评估强直性脊柱炎（AS）疼痛或肿胀方面的可靠性。
要求217名符合修订纽约AS标准的门诊患者在分别展示44个和40个关节的两个人体模型上标记疼痛关节和肿胀关节。在患者完成标记后，由医生或研究护士在同一天对相同关节进行疼痛和肿胀评估，且不告知患者评估结果。
46名（21%）患者报告有一个或多个肿胀关节（肿胀关节的平均数为0.5，范围为0 - 8）；医生发现54名（25%）患者有一个或多个肿胀关节（肿胀关节的平均数为0.8，范围为0 - 31）。患者与医生在肿胀关节数量上的总体一致性为中等（组内相关系数（ICC）0.53）。在单个肿胀关节上的一致性为差到中等（kappa值0.1 - 0.64）。128名（60%）患者报告有压痛关节（关节平均数为2.4，范围为0 - 26）。医生报告50%的患者有一个或多个压痛关节（压痛关节的平均数为2.2，范围为0 - 34）。总体一致性也为中等（ICC 0.71）。在单个压痛关节上的一致性同样为差到中等（kappa值0.19 - 0.43）。医生与患者在无肿胀关节方面仅有高度一致性（82%）。在单关节炎、少关节炎或多关节炎存在方面的一致性较低（17% - 22%）。
由于在单个关节和受累关节总数评估上存在这些差异，医生评估的AS关节计数不能被患者报告的关节计数所取代。患者仅能判断其关节是否未肿胀。
