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Development and testing of reduced joint counts in juvenile idiopathic arthritis
Anna Bazso1, Alessandro Consolaro, Nicolino Ruperto
1Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Largo G. Gaslini 5, 16147 Genova, Italy.
Insights
Simplified joint counts are as reliable as standard assessments for tracking juvenile idiopathic arthritis (JIA) severity and disease progression in children. A 27-joint count is recommended for clinical use.
Area of Science:
- Pediatric Rheumatology
- Clinical Assessment
- Biostatistics
Background:
- Juvenile idiopathic arthritis (JIA) requires accurate joint assessment for disease monitoring.
- Standard joint counts can be time-consuming and complex in clinical practice.
- Developing simplified joint counts may improve efficiency without compromising reliability.
Purpose of the Study:
- To develop and validate reduced joint counts for assessing JIA.
- To compare the performance of reduced joint counts against standard comprehensive joint counts.
- To identify a feasible and reliable reduced joint count for clinical application in JIA.
Main Methods:
- A panel of pediatric rheumatologists devised four reduced joint counts (45, 35, 27, 10 joints).
- Joint selection was based on assessment ease, functional relevance, and involvement frequency.
- Three large JIA patient samples (n=4353) were used to test reduced counts against standard counts, construct validity, and responsiveness.
Main Results:
- Reduced joint counts demonstrated comparable Spearman correlations with the standard joint count, indicating similar surrogate ability.
- Construct validity and responsiveness to clinical change (SRM 0.63-1.09) were also comparable across reduced counts.
- A 27-joint count, including specific joints like the cervical spine, elbows, wrists, and lower limb joints, is proposed for JIA assessment.
Conclusions:
- Reduced joint counts offer a reliable alternative to standard joint counts for assessing JIA severity.
- These simplified counts are effective in evaluating disease status and changes over time in pediatric patients with JIA.
- The proposed 27-joint count balances feasibility and reliability for clinical use in JIA management.
Objective:
To develop and test reduced joint counts in children with juvenile idiopathic arthritis (JIA).
Methods:
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).
Results:
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.
Conclusion:
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.
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