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Rheumatology Advance Access published online on October 18, 2005
Rheumatology, doi:10.1093/rheumatology/kei161
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received June 1, 2005
Accepted September 14, 2005

Original Articles

Weighting improves the information provided by joint counts on the severity of arthritis and its impact on patients’ well-being in juvenile idiopathic arthritis

M. Bandeira 1, A. Falcone 2, A. Pistorio 3, N. Ruperto 4, S. Magni-Manzoni 5, A. Buoncompagni 4, E. Sala 4, A. Loy 4, A. Martini 4, and A. Ravelli 4*

1 Dipartimento di Pediatria, Università di Genova, Istituto di Ricovero e Cura a Carattee Scientifico G. Gaslini, Genova, Italy; Hospital Pequeno Principe, Curitiba, Brasil
2 Dipartimento di Pediatria, Università di Genova, Istituto di Ricovero e Cura a Carattee Scientifico G. Gaslini, Genova, Italy; Dipartimento di Pediatria, Università di Messina, Messina, Italy
3 Servizio di Epidemiologia e Biostatistica, Direzione Scientifica, Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genova, Italy
4 Dipartimento di Pediatria, Università di Genova, Istituto di Ricovero e Cura a Carattee Scientifico G. Gaslini, Genova, Italy
5 Dipartimento di Pediatria, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia, Italy

* To whom correspondence should be addressed.
A. Ravelli, E-mail: angeloravelli{at}ospedale-gaslini.ge.it


  Abstract

Objective. To develop a scoring system for juvenile idiopathic arthritis (JIA) in which joints are weighted to reflect their relative importance to children's function and to examine whether weighting increases the correlation of joint counts with subjective and laboratory outcome measures.

Methods. A weighted joint score was devised by a panel of experienced paediatric rheumatologists, who assigned a weight from 1 (not very important) to 10 (essential for key functional activities) to each joint based on its functional importance to children's physical and daily activities. The associations of simple and weighted counts of swollen, tender, limited and active joints with the physician's global assessment of overall disease activity, the parent's global assessment of the child's overall well-being and intensity of pain, the Childhood Health Assessment Questionnaire (C-HAQ), the Child Health Questionnaire (CHQ) and the erythrocyte sedimentation rate were compared using Spearman's correlation analysis in 60 unselected patients seen in the clinic and in 61 consecutive patients with disease duration ≥5 yr.

Results. Weighted counts of swollen and active joints yielded greater correlation with the physician's global assessment than did simple counts. The correlation of weighted counts of swollen, painful and active joints with the parent's assessment of overall well-being and intensity of pain was superior to that provided by simple counts. Weighting increased most of the correlations between joint counts and the C-HAQ score and the physical component of the CHQ.

Conclusion. Weighting improves the information provided by joint counts on the severity of arthritis and its impact on patients’ well-being.

Keywords: Juvenile idiopathic arthritis; Juvenile rheumatoid arthritis; Juvenile chronic arthritis; Joint counts; Articular scores; Weighting.
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