Guzmán J, Burgos-Vargas R, Duarte-Salazar C, Gómez-Mora P
Department of Immunology and Rheumatology, Instituto Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
J Rheumatol. 1995 Dec;22(12):2331-6.
To assess the interobserver agreement of articular examination in children with juvenile rheumatoid arthritis (JRA) and identify sources of disagreement.
Four rheumatologists graded tenderness/pain on motion, swelling, and limitation of motion in the joints of 10 children with JRA, as recommended by the Pediatric Rheumatology Collaborative Study Group, and 17 different joint indices were computed. Agreement was measured by kappa (kappa) and intraclass correlation coefficients (Ri).
All 4 observers detected tenderness in 15.7% of the joints, but they disagreed (2 vs 2) on 4.2% (kappa = 0.71). They detected swelling in 5.2% but disagreed on 6.2% (kappa = 0.47). They found limitation in 4.9%, but disagreed on 8.1% (kappa = 0.54). The tender joint count, and the American Rheumatism Association cooperating clinics and Hart modified Ritchie indices were the most reliable (Ri > 0.93); the swelling severity index fared the worst (Ri = 0.40). There were differences in examination maneuvers and judgment among examiners. Discrepancies were larger in metacarpophalangeal joints and in patients with many involved joints.
There was low agreement in the assessment of joint swelling and limitation of motion. Differences in examiners' techniques, patients with severe disease, and the small hand joints were important sources of disagreement.
评估幼年类风湿关节炎（JRA）患儿关节检查中观察者间的一致性，并确定不一致的来源。
按照儿科风湿病协作研究组的建议，4名风湿病学家对10例JRA患儿的关节压痛/活动时疼痛、肿胀及活动受限情况进行分级，并计算17种不同的关节指数。采用kappa（κ）和组内相关系数（Ri）来衡量一致性。
所有4名观察者均在15.7%的关节中检测到压痛，但在4.2%的关节上存在分歧（2人对2人）（κ = 0.71）。他们在5.2%的关节中检测到肿胀，但在6.2%的关节上存在分歧（κ = 0.47）。他们发现4.9%的关节存在活动受限，但在8.1%的关节上存在分歧（κ = 0.54）。压痛关节计数、美国风湿病协会合作诊所及哈特改良里奇指数最为可靠（Ri > 0.93）；肿胀严重程度指数表现最差（Ri = 0.40）。检查者之间在检查手法和判断上存在差异。掌指关节及受累关节较多的患者中差异更大。
在关节肿胀和活动受限的评估中一致性较低。检查者技术差异、重症患者以及小手关节是不一致的重要来源。
