Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
幼年特发性关节炎（JIA）是儿童最常见的风湿性疾病，下肢受累非常普遍。最近的证据表明，临床医生缺乏特定的下肢体检（PE）工具，可帮助儿科风湿病团队识别JIA患者的下肢疾病。早期临床检测可能导致更及时和有针对性的干预措施，以减少JIA儿童的下肢问题。这项初步研究的目的是提供有关JIA下肢PE工具诊断准确性的初步数据。
根据常规护理需要对下肢关节进行磁共振成像（MRI）的JIA儿童符合资格。下肢关节计数是由足病医生和儿科风湿病学家在临床上使用每侧20个关节进行的，PE工具。将PE与两名独立的儿科放射科医生完成的MRI评估进行比较。使用协议分析数据(观察，阳性和阴性)和科恩的κ，CI为95%。
研究招募了15名参与者，对600个下肢关节进行了临床检查。统计分析显示，足病医生和儿科风湿病学家在关节肿胀和压痛方面具有出色的评分者间可靠性。使用PE工具的足病医生的评分者内部可靠性结果表明，良好的百分比一致性（98.5-100％）和可观的kappa系数（0.93-1）。放射学评估之间的评估者间可靠性对比了PE结果，表现出低一致性和差的可靠性。PE和MRI之间的比较导致kappa系数差和一致性百分比低。MRI和PE之间最合适的关节是踝关节，而表现最差的关节是距骨下关节。
结果表明潜在的临床可靠性；然而，由于低kappa系数以及PE和MRI结果之间的一致性不一致,所提出的PE工具的有效性和诊断准确性尚不清楚.在将该工具用于临床环境之前，还需要进一步的研究。
根据常规护理需要对下肢关节进行磁共振成像（MRI）的JIA儿童符合资格。下肢关节计数是由足病医生和儿科风湿病学家在临床上使用每侧20个关节进行的，PE工具。将PE与两名独立的儿科放射科医生完成的MRI评估进行比较。使用协议分析数据(观察，阳性和阴性)和科恩的κ，CI为95%。
研究招募了15名参与者，对600个下肢关节进行了临床检查。统计分析显示，足病医生和儿科风湿病学家在关节肿胀和压痛方面具有出色的评分者间可靠性。使用PE工具的足病医生的评分者内部可靠性结果表明，良好的百分比一致性（98.5-100％）和可观的kappa系数（0.93-1）。放射学评估之间的评估者间可靠性对比了PE结果，表现出低一致性和差的可靠性。PE和MRI之间的比较导致kappa系数差和一致性百分比低。MRI和PE之间最合适的关节是踝关节，而表现最差的关节是距骨下关节。
结果表明潜在的临床可靠性；然而，由于低kappa系数以及PE和MRI结果之间的一致性不一致,所提出的PE工具的有效性和诊断准确性尚不清楚.在将该工具用于临床环境之前，还需要进一步的研究。
