Bunn D K, Shepstone L, Galpin L M, Wiles N J, Symmons D P M
Norfolk Arthritis Register, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK.
Rheumatology (Oxford). 2004 Dec;43(12):1519-25. doi: 10.1093/rheumatology/keh372. Epub 2004 Aug 17.
To evaluate the reliability and validity of the Norfolk Arthritis Register Damaged Joint Count (NOAR-DJC) in patients with early inflammatory polyarthritis (IP).
The NOAR-DJC examines deformity in 51 joints. Deformity is defined as inability to adopt the anatomical position, reduction in range of movement by at least one-third, and/or surgical alteration of the joint. Reliability was investigated by assessing intra- and inter-observer agreement in 40 and 32 patients, respectively. Validity was assessed by correlating the NOAR-DJC with the eroded joint count (criterion validity), the Health Assessment Questionnaire (HAQ) (convergent construct validity) and tender and swollen joint counts (divergent construct validity) and by discriminating between those who did and did not satisfy criteria for rheumatoid arthritis (discriminant validity).
The intraclass correlation coefficient for the intra- and inter-rater studies were 0.88 [95% confidence interval (CI) 0.79, 0.94, P<0.00001] and 0.74 (95% CI 0.53, 0.86, P<0.00001), respectively. Correlations with eroded joint counts and HAQ scores after 5 yr follow-up were r(s) = 0.42 (95% CI 0.35, 0.49, P<0.01) and r(s) = 0.45 (95% CI 0.4, 0.5, P<0.01), respectively. Correlations with tender and swollen joint counts were weak (r(s) = 0.28 and r(s) = 0.33).
The NOAR-DJC is a quick, reliable and valid tool for assessing articular damage in patients with early IP.
评估诺福克关节炎登记损伤关节计数（NOAR - DJC）在早期炎症性多关节炎（IP）患者中的可靠性和有效性。
NOAR - DJC检查51个关节的畸形情况。畸形定义为无法采取解剖位置、活动范围至少减少三分之一和/或关节的手术改变。通过分别评估40例和32例患者的观察者内和观察者间一致性来研究可靠性。通过将NOAR - DJC与侵蚀关节计数（标准效度）、健康评估问卷（HAQ）（收敛性结构效度）以及压痛和肿胀关节计数（发散性结构效度）进行关联，并区分符合和不符合类风湿关节炎标准的患者（判别效度）来评估有效性。
观察者内和观察者间研究的组内相关系数分别为0.88 [95%置信区间（CI）0.79，0.94，P < 0.00001]和0.74（95% CI 0.53，0.86，P < 0.00001）。5年随访后与侵蚀关节计数和HAQ评分的相关性分别为r(s)=0.42（95% CI 0.35，0.49，P < 0.01）和r(s)=0.45（95% CI 0.4，0.5，P < 0.01）。与压痛和肿胀关节计数的相关性较弱（r(s)=0.28和r(s)=0.33）。
NOAR - DJC是评估早期IP患者关节损伤的一种快速、可靠且有效的工具。
