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Sensitivity and specificity of criteria for spondyloarthritis in children with late onset pauciarticular juvenile chronic arthritis as well as their characteristics

Rik Joos, Jo Dehoorne UGent, Ilse Hoffman, Herman Mielants UGent, August Verbruggen UGent and Dirk Elewaut UGent (2009) Clinical and experimental rheumatology. 27(5). p.870-876
abstract
Objective To evaluate the sensitivity and specificity of criteria designed for spondyloarthritis a university hospital treated Population of children with late onset pauciarticular juvenile, chronic arthritis and a control population. Methods Four sets of criteria especially designed for juvenile patients: Garmisch-Partenkirchen juvenile spondylitis criteria (= Garmisch), SEA (=seronegative enthesopathy and arthritis)syndrome, Enthesitis Related Arthritis (ERA), Atypical spondyloarthritis for children and two sets of criteria for patients without age specification (European spondyloarthropathy Study, Group - ESSG and Amor) were evaluated it? a cross-sectional way in a group of 43 consecutive patients with late onset pauciarticular juvenile chronic arthritis (LOPA) seen over a six-month period in the outpatient clinic. These criteria were analysed in 69 patients with other forms of juvenile chronic arthritis as well. The sensitivity and specificity were calculated for each set, as well as positive predictive value and likelihood ratio. The characteristics described in the different sets of criteria were separately evaluated in the LOPA patients and the other patients. Results For sensitivity, the Garmisch criteria scored the highest value (97.7%). However, sensitivity was significantly lower in two of the juvenile sets (SEA syndrome and Atypical spondyloarthritis), respectively 44.2% criteria (>85%; P<0.01 by Me Nemar test). Specificity and predictive value (PPV) was the highest for the SEA syndrome criteria (98.5%, vs. 95.0%).followed by the ERA (95.6% vs. 92.1%) and the Garmisch criteria (94.2% vs. 91.3%). The positive likelihood ratio (LR+) was >10 in SEA (30.5), ERA (18.7) and Garmisch (16.8). The negative likelihood ratio (LR-) was <0.1 only in the Garmisch criteria (0.02). Conclusion Sensitivity, specificity, PPV LR+ and LR- for the Garmisch-Partenkirchen criteria suggest that the), classify almost the same population (is defined by LOPA. The SEA syndrome criteria, which were not designed to be classification criteria, being very specific, cannot be used in this patient population to classify a sufficient number of patients. The sensitivity and specificity for the ESSG criteria being similar in these children as in adults suggest they have similar characteristics. The Garmisch-Partenkirchen criteria and/or LOPA definition are major candidates for future research it? identifying spondyloarthritis in juvenile patients.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
journal title
Clinical and experimental rheumatology
Clin. Exp. Rheumatol.
volume
27
issue
5
pages
870 - 876
Web of Science type
Article
Web of Science id
000272278400160
JCR category
RHEUMATOLOGY
JCR impact factor
2.396 (2009)
JCR rank
15/24 (2009)
JCR quartile
3 (2009)
ISSN
0392-856X
language
English
UGent publication?
yes
classification
A1
id
846097
handle
http://hdl.handle.net/1854/LU-846097
date created
2010-01-29 14:36:06
date last changed
2010-02-03 14:04:29
@article{846097,
  abstract     = {Objective

To evaluate the sensitivity and specificity of criteria designed for spondyloarthritis a university hospital treated Population of children with late onset pauciarticular juvenile, chronic arthritis and a control population.

Methods

Four sets of criteria especially designed for juvenile patients: Garmisch-Partenkirchen juvenile spondylitis criteria (= Garmisch), SEA (=seronegative enthesopathy and arthritis)syndrome, Enthesitis Related Arthritis (ERA), Atypical spondyloarthritis for children and two sets of criteria for patients without age specification (European spondyloarthropathy Study, Group - ESSG and Amor) were evaluated it? a cross-sectional way in a group of 43 consecutive patients with late onset pauciarticular juvenile chronic arthritis (LOPA) seen over a six-month period in the outpatient clinic. These criteria were analysed in 69 patients with other forms of juvenile chronic arthritis as well. The sensitivity and specificity were calculated for each set, as well as positive predictive value and likelihood ratio. The characteristics described in the different sets of criteria were separately evaluated in the LOPA patients and the other patients.

Results

For sensitivity, the Garmisch criteria scored the highest value (97.7\%). However, sensitivity was significantly lower in two of the juvenile sets (SEA syndrome and Atypical spondyloarthritis), respectively 44.2\% criteria ({\textrangle}85\%; P{\textlangle}0.01 by Me Nemar test). Specificity and predictive value (PPV) was the highest for the SEA syndrome criteria (98.5\%, vs. 95.0\%).followed by the ERA (95.6\% vs. 92.1\%) and the Garmisch criteria (94.2\% vs. 91.3\%). The positive likelihood ratio (LR+) was {\textrangle}10 in SEA (30.5), ERA (18.7) and Garmisch (16.8). The negative likelihood ratio (LR-) was {\textlangle}0.1 only in the Garmisch criteria (0.02).

Conclusion

Sensitivity, specificity, PPV LR+ and LR- for the Garmisch-Partenkirchen criteria suggest that the), classify almost the same population (is defined by LOPA. The SEA syndrome criteria, which were not designed to be classification criteria, being very specific, cannot be used in this patient population to classify a sufficient number of patients. The sensitivity and specificity for the ESSG criteria being similar in these children as in adults suggest they have similar characteristics. The Garmisch-Partenkirchen criteria and/or LOPA definition are major candidates for future research it? identifying spondyloarthritis in juvenile patients.},
  author       = {Joos, Rik and Dehoorne, Jo and Hoffman, Ilse and Mielants, Herman and Verbruggen, August and Elewaut, Dirk},
  issn         = {0392-856X},
  journal      = {Clinical and experimental rheumatology},
  language     = {eng},
  number       = {5},
  pages        = {870--876},
  title        = {Sensitivity and specificity of criteria for spondyloarthritis in children with late onset pauciarticular juvenile chronic arthritis as well as their characteristics},
  volume       = {27},
  year         = {2009},
}

Chicago
Joos, Rik, Jo Dehoorne, Ilse Hoffman, Herman Mielants, August Verbruggen, and Dirk Elewaut. 2009. “Sensitivity and Specificity of Criteria for Spondyloarthritis in Children with Late Onset Pauciarticular Juvenile Chronic Arthritis as Well as Their Characteristics.” Clinical and Experimental Rheumatology 27 (5): 870–876.
APA
Joos, R., Dehoorne, J., Hoffman, I., Mielants, H., Verbruggen, A., & Elewaut, D. (2009). Sensitivity and specificity of criteria for spondyloarthritis in children with late onset pauciarticular juvenile chronic arthritis as well as their characteristics. Clinical and experimental rheumatology, 27(5), 870–876.
Vancouver
1.
Joos R, Dehoorne J, Hoffman I, Mielants H, Verbruggen A, Elewaut D. Sensitivity and specificity of criteria for spondyloarthritis in children with late onset pauciarticular juvenile chronic arthritis as well as their characteristics. Clinical and experimental rheumatology. 2009;27(5):870–6.
MLA
Joos, Rik, Jo Dehoorne, Ilse Hoffman, et al. “Sensitivity and Specificity of Criteria for Spondyloarthritis in Children with Late Onset Pauciarticular Juvenile Chronic Arthritis as Well as Their Characteristics.” Clinical and experimental rheumatology 27.5 (2009): 870–876. Print.