Goycochea-Robles Maria-Victoria, Sanin Luz Helena, Moreno-Montoya José, Alvarez-Nemegyei José, Burgos-Vargas Rubén, Garza-Elizondo Mario, Rodríguez-Amado Jacqueline, Madariaga Marco A, Zamudio Jorge A, Cuervo Gisela Espinosa, Cardiel-Ríos Mario Humberto, Peláez-Ballestas Ingris
Unidad de Investigación, HGR No. 1 IMSS, Colegio Mexicano de Reumatología, México City, Mexico.
J Rheumatol Suppl. 2011 Jan;86:31-5. doi: 10.3899/jrheum.100955.
Rheumatic diseases are vastly underdiagnosed and undertreated, particularly among minorities and those of low socioeconomic status. The WHO-ILAR Community Oriented Program in the Rheumatic Diseases (COPCORD) advocates screening of musculoskeletal complaints in the community. The objective of this study was to evaluate the performance of the COPCORD Core Questionnaire (CCQ) as a diagnostic tool for rheumatic diseases.
We conducted a cross-sectional study designed in parallel with a large COPCORD survey in Mexico. A subsample of 17,566 questionnaires, selected from 4 of the 5 states included in a national COPCORD survey were included in the analysis as a diagnostic test to evaluate sensitivity, specificity, receiver operating characteristics curve (ROC), and positive likelihood ratio (LR+) of the CCQ as a case-detection tool for rheumatic diagnosis and for the most frequent diagnoses identified in the survey, osteoarthritis, regional rheumatic pain syndromes, and rheumatoid arthritis (RA). Logistic regression with the questions with LR+ ≥ 1 was performed to identify the strength of association (OR) for each question.
Pain in the last 7 days, high pain score (> 4), and previous diagnosis were the questions with highest LR+ for diagnosis, and for diagnosis of RA treatment with NSAID. The variables that contributed most to the model were pain in the last 7 days (OR 2.0, 95% CI 1.8-2.3), NSAID treatment (OR 3.3, 95% CI 3.0-3.7), a high pain score (OR 1.15, 95% CI 1.13-1.17), and having a previous diagnosis (OR 1.4, 95% CI 1.3-1.6). These 4 questions had R(2) = 0.24, p < 0.01, for detection of any rheumatic diagnosis. The single variable that explains 16% (OR 1.33, 95% CI 1.31-134) of variance was a high pain score in the last 7 days.
Some variables were identified in the CCQ that could be combined in a brief version for case detection of rheumatic diseases in community surveys. The validity of this proposal has to be tested against the original version.
风湿性疾病的诊断和治疗严重不足，在少数族裔和社会经济地位较低的人群中尤为如此。世界卫生组织-国际抗风湿联盟社区导向型风湿性疾病项目（COPCORD）提倡在社区中筛查肌肉骨骼疾病。本研究的目的是评估COPCORD核心问卷（CCQ）作为风湿性疾病诊断工具的性能。
我们开展了一项横断面研究，与墨西哥的一项大型COPCORD调查并行设计。从全国COPCORD调查所涵盖的5个州中的4个州选取的17566份问卷的子样本被纳入分析，作为一项诊断测试，以评估CCQ作为风湿性疾病诊断及该调查中最常见诊断（骨关节炎、区域性风湿性疼痛综合征和类风湿关节炎（RA））的病例检测工具的敏感性、特异性、受试者工作特征曲线（ROC）和阳性似然比（LR+）。对LR+≥1的问题进行逻辑回归，以确定每个问题的关联强度（OR）。
过去7天内的疼痛、高疼痛评分（>4）和既往诊断是诊断及RA诊断中使用非甾体抗炎药治疗的LR+最高的问题。对模型贡献最大的变量是过去7天内的疼痛（OR 2.0，95%CI 1.8 - 2.3）、非甾体抗炎药治疗（OR 3.3，95%CI 3.0 - 3.7）、高疼痛评分（OR 1.15，95%CI 1.13 - 1.17）和有既往诊断（OR 1.4，95%CI 1.3 - 1.6）。这4个问题对任何风湿性疾病诊断的检测的R(2)=0.24，p<0.01。解释16%（OR 1.33，95%CI 1.31 - 1.34）方差的单一变量是过去7天内的高疼痛评分。
在CCQ中识别出了一些变量，可将其组合成一个简短版本，用于社区调查中风湿性疾病的病例检测。该提议的有效性必须与原始版本进行对比测试。
