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Physical Examination Tool for Swollen and Tender Lower Limb Joints in Juvenile Idiopathic Arthritis: A Pilot
Antoni Fellas1, Davinder Singh-Grewal2, Jeffrey Chaitow2
1School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle 2308, Australia.
Insights
A new physical examination (PE) tool shows promise for assessing lower limb involvement in juvenile idiopathic arthritis (JIA). While reliable for clinicians, its diagnostic accuracy compared to MRI needs further investigation for JIA patients.
Area of Science:
- Pediatric Rheumatology
- Musculoskeletal Imaging
- Clinical Assessment Tools
Background:
- Juvenile idiopathic arthritis (JIA) frequently affects lower limbs, necessitating effective diagnostic tools.
- Current physical examination (PE) methods for lower extremity disease in JIA lack specificity.
- Early detection of lower limb issues in JIA is crucial for timely interventions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of a novel lower limb PE tool in children with JIA.
- To provide preliminary data on the reliability and validity of the PE tool.
Main Methods:
- A pilot study involving children with JIA undergoing lower limb MRI.
- Clinical joint counts using a 20-joint PE tool by a podiatrist and pediatric rheumatologist.
- Comparison of PE findings with MRI assessments by two independent pediatric radiologists.
- Statistical analysis using agreement metrics and Cohen's kappa.
Main Results:
- Excellent inter-rater reliability was observed between clinicians for joint swelling and tenderness.
- High intra-rater reliability was found for the podiatrist using the PE tool.
- Low agreement and poor reliability were noted between PE and MRI results, particularly for subtalar joints.
- The ankle joint showed the highest agreement between PE and MRI.
Conclusions:
- The proposed lower limb PE tool demonstrates potential clinical reliability among healthcare providers.
- The diagnostic accuracy and validity of the PE tool require further research due to discrepancies with MRI findings.
- Additional studies are necessary before widespread clinical adoption of this JIA assessment tool.
Background:
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children, with lower limb involvement highly prevalent. Recent evidence has highlighted the lack of specific lower limb physical examination (PE) tools for clinicians assisting the paediatric rheumatology team in identifying lower extremity disease in patients with JIA. Early clinical detection may lead to more prompt and targeted interventions to reduce lower limb problems in children with JIA. The aim of this pilot study is to provide preliminary data on the diagnostic accuracy of a lower limb PE tool in JIA.
Methods:
Children with JIA requiring magnetic resonance imaging (MRI) on their lower limb joints per their usual care were eligible. Lower limb joint counts were conducted clinically by a podiatrist and paediatric rheumatologist using the proposed twenty joint per side, PE tool. The PE were compared to MRI assessments completed by two independent paediatric radiologists. Data were analysed using agreement (observed, positive and negative) and Cohen's kappa with 95% CIs.
Results:
Fifteen participants were recruited into the study in which 600 lower limb joints were clinically examined. Statistical analysis showed excellent inter-rater reliability between podiatrist and paediatric rheumatologist for both joint swelling and tenderness. Results of the intra-rater reliability of the podiatrist using the PE tool indicated excellent percentage agreements (98.5-100%) and substantial kappa coefficients (0.93-1). The inter-rater reliability between radiological assessments contrasted the PE results, showing low agreement and poor reliability. Comparisons between PE and MRI resulted in poor kappa coefficients and low agreement percentages. The most agreeable joint between MRI and PE was the ankle joint, while the worst performing joint was the sub-talar joint.
Conclusion:
Results indicate potential clinical reliability; however, the validity and diagnostic accuracy of the proposed PE tool remains unclear due to low kappa coefficients and inconsistent agreements between PE and MRI results. Further research will be required before the tool may be used in a clinical setting.
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