RESEARCH - The NOAR DJC: a clinical measure for assessing articular damage in patients with early IP including RA

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Rheumatology Advance Access published online on August 17, 2004

Rheumatology, doi:10.1093/rheumatology/keh372

Rheumatology © British Society for Rheumatology 2004; all rights

reserved

Received January 4, 2004

Accepted July 13, 2004

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Original Papers

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. Bunn 1*, L. Shepstone 2, L. M. Galpin 1, N. J. Wiles 3, D. P. M.

Symmons 4

1 Norfolk Arthritis Register, Norfolk and Norwich University Hospital,

Norwich, UK

2 School of Medicine, Health Policy and Practice, University of East

Anglia, Norwich, UK

3 Division of Psychiatry, University of Bristol, Bristol, UK

4 ARC Epidemiology Unit, University of Manchester, Manchester, UK

* To whom correspondence should be addressed. E-mail:

diane@....

Abstract

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.

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