Background/Purpose:

Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory rheumatologic disease in children and adolescents with a prevalence of 1:1000 children in Germany. An early referral of children suspected to have JIA to a pediatric rheumatologist is essential for an early diagnosis and starting treatment to reach a better outcome. An easy-to-use and time efficient questionnaire originally developed by a group led by Claudio Len may detect children and adolescent under risk for JIA.

Methods:

The questionnaire was translated into German by I. Foeldvari and were distributed among patients at the first clinical visit. It includes 12 disease-orientated questions with three possible responses, either: “Yes”, “No” or “I don’t know”. A retrospective evaluation of patients diagnosed with JIA or with a non-inflammatory joint pain (NJP) was performed later on. The sample consisted of patients seen between August 2015 and July 2017. All patients were at least older than 2 years and younger than 17 years at the time of evaluation. Only fully answered questionnaires were evaluated. Subsequently, a weighting scheme of individual questions was applied in order to increase the sensitivity of the tool. Standard statistical techniques were used to find associations between the sum scores and clinical characteristics and to compare the weighted and non-weighted sum scores.

Results:

In total 165 of 800 questionnaires could be evaluated for the study. 133 (81%) were diagnosed with JIA and 32 (19%) with NJP. The group of JIA patients consisted of 79 (59%) girls, whereas the control group consisted of 21 (66%) girls. The analysis of the individual questions was performed by comparing the rate of a positive response to the questions (“Yes”) between the two groups. Four questions showed a highly significant difference by comparing answers of the control group with a subgroup of JIA patients having at least one active inflammatory joint. In particular, questions regarding physical constraints (p= 0.20; AUC= 0.62), joint pain (p= 0.040; AUC = 0.61), swelling in the joints (p= 0.040; AUC =0.60) and stamina (p= 0.047; AUC = 0.60) seem to be relevant in the diagnostic approach. A weight of 3 was assigned to the first and seventh, 2.5 to the fourth and sixth, and 1.5 to the third and fifth item. The diagnostic accuracy of the respective weighted sum score increased from 64% to 68% to discriminate between patients with JIA with at least one active joint and the control group in comparison to the ordinary sum score. An optimal cutoff of 6.0 for referral to a pediatric specialist was calculated.

Conclusion:

The validation of the questionnaire showed a discriminative difference in patients with clinical diagnosed JIA and a control group diagnosed with NJP. Furthermore, the weighted sum score performed better to differentiate between JIA and NJP patients. The modified questionnaire can be useful to screen for JIA and speed up the referral to a pediatric rheumatologist.

« Back to 2018 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/validating-and-developing-a-selected-questionnaire-to-predict-early-diagnosis-of-juvenile-idiopathic-arthritis-in-german-population/