Bazso Anna, Consolaro Alessandro, Ruperto Nicolino, Pistorio Angela, Viola Stefania, Magni-Manzoni Silvia, Malattia Clara, Buoncompagni Antonella, Loy Anna, Martini Alberto, Ravelli Angelo
Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Largo G. Gaslini 5, 16147 Genova, Italy.
J Rheumatol. 2009 Jan;36(1):183-90. doi: 10.3899/jrheum.080432.
To develop and test reduced joint counts in children with juvenile idiopathic arthritis (JIA).
Four reduced joint counts including 45, 35, 27, and 10 joints were devised by a panel of experienced pediatric rheumatologists, who selected the joints to be included based on the ease of technical assessment, functional relevance, and frequency of involvement. Three large samples of patients with JIA (total n=4353) who had a detailed joint assessment available were used to develop and test reduced joint counts. Performance of reduced counts was examined by comparing their Spearman correlation with the standard (i.e., complete) joint count. Construct validity was evaluated by calculating Spearman correlation with other JIA outcome measures. Responsiveness to clinical change was determined through the standardized response mean (SRM).
Spearman correlations of reduced joint counts with the whole joint count and with the other JIA outcome measures were comparable, revealing that they had similar ability to serve as surrogate for the whole joint count and construct validity. Responsiveness to clinical change was also comparable across reduced counts (SRM 0.83-1.09 for active joint counts and 0.63-0.81 for restricted joint counts). Based on these results and considering the relative feasibility of the different counts, the 27-joint reduced count is proposed for use in JIA. This joint count includes the cervical spine and the elbow, wrist, metacarpophalangeal (from first to third), proximal interphalangeal, hip, knee, and ankle joints.
Reduced joint counts appear to be as reliable as standard joint counts in assessment of the severity of joint disease and its change over time in children with JIA.
制定并测试用于幼年特发性关节炎（JIA）患儿的简化关节计数法。
由一组经验丰富的儿科风湿病学家设计了四种简化关节计数法，分别包括45个、35个、27个和10个关节，他们根据技术评估的难易程度、功能相关性和受累频率来选择纳入的关节。利用三个有详细关节评估的JIA患者大样本（总计n = 4353）来制定和测试简化关节计数法。通过比较简化计数法与标准（即完整）关节计数法的斯皮尔曼相关性来检验其性能。通过计算与其他JIA结局指标的斯皮尔曼相关性来评估结构效度。通过标准化反应均值（SRM）确定对临床变化的反应性。
简化关节计数法与全关节计数法以及其他JIA结局指标的斯皮尔曼相关性相当，表明它们作为全关节计数法替代指标的能力和结构效度相似。不同简化计数法对临床变化的反应性也相当（活动关节计数法的SRM为0.83 - 1.09，受限关节计数法的SRM为0.63 - 0.81）。基于这些结果并考虑到不同计数法的相对可行性，建议在JIA中使用27关节简化计数法。该关节计数法包括颈椎以及肘、腕、掌指关节（第一至第三）、近端指间关节、髋、膝和踝关节。
在评估JIA患儿关节疾病的严重程度及其随时间的变化时，简化关节计数法似乎与标准关节计数法一样可靠。
