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Rheumatology Advance Access originally published online on August 17, 2004
Rheumatology 2004 43(12):1519-1525; doi:10.1093/rheumatology/keh372
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Rheumatology Vol. 43 No. 12 © British Society for Rheumatology 2004; all rights reserved


PAPER

The NOAR Damaged Joint Count (NOAR-DJC): a clinical measure for assessing articular damage in patients with early inflammatory polyarthritis including rheumatoid arthritis

D. K. Bunn1, L. Shepstone2, L. M. Galpin1, N. J. Wiles3 and D. P. M. Symmons4

1 Norfolk Arthritis Register, Norfolk and Norwich University Hospital, 2 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, 3 Division of Psychiatry, University of Bristol, Bristol and 4 ARC Epidemiology Unit, University of Manchester, Manchester, UK.

Correspondence to: D. Bunn, Norfolk Arthritis Register, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, UK. E-mail: diane{at}fs1.ser.man.ac.uk

Objectives. To evaluate the reliability and validity of the Norfolk Arthritis Register Damaged Joint Count (NOAR-DJC) in patients with early inflammatory polyarthritis (IP).

Methods. The NOAR-DJC examines deformity in 51 joints. Deformity is defined as inability to adopt the anatomical position, reduction in range of movement by at least one-third, and/or surgical alteration of the joint. Reliability was investigated by assessing intra- and inter-observer agreement in 40 and 32 patients, respectively. Validity was assessed by correlating the NOAR-DJC with the eroded joint count (criterion validity), the Health Assessment Questionnaire (HAQ) (convergent construct validity) and tender and swollen joint counts (divergent construct validity) and by discriminating between those who did and did not satisfy criteria for rheumatoid arthritis (discriminant validity).

Results. The intraclass correlation coefficient for the intra- and inter-rater studies were 0.88 [95% confidence interval (CI) 0.79, 0.94, P<0.00001] and 0.74 (95% CI 0.53, 0.86, P<0.00001), respectively. Correlations with eroded joint counts and HAQ scores after 5 yr follow-up were rs = 0.42 (95% CI 0.35, 0.49, P<0.01) and rs = 0.45 (95% CI 0.4, 0.5, P<0.01), respectively. Correlations with tender and swollen joint counts were weak (rs = 0.28 and rs = 0.33).

Conclusion. The NOAR-DJC is a quick, reliable and valid tool for assessing articular damage in patients with early IP.

KEY WORDS: Inflammatory polyarthritis, NOAR, Damaged Joint Count, Clinical assessment


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