Len et al developed a tool for identifying a pediatric patient with chronic arthropathy who should be referred to a rheumatologist. The authors are from Escola Paulista de Medicina, Sao Paulo, Brazil.
Tool: 12 questions used to interview the patient's parents
Clusters of questions:
(1) swelling and other features of joint appearance
(2) pain and discomfort in joint
(3) difficulty or impairments in activities
NOTE: The leading numbers correspond to the item number of the original questionnaire in Table 3 (page 375). Questions 11 and 12 started "swelling or pain"; these were divided between the 3 clusters but summated as an OR for scoring..
Joint appearance:
(1) swelling of joints in past 7 days
(3) swelling of joints lasting > 30 days
(10) joint deformity
(11a) swelling after a febrile illness
(12a) swelling after an episode of skin redness
Pain or discomfort:
(2) pain in a joint during past 7 days
(4) pain in a joint lasting > 30 days
(8) awakening with complaints about joints
(11b) painful joint after a febrile illness
(12b) painful joint after an episode of skin redness
Difficulty or impairment:
(5) difficulty in moving joints of hand, wrists, knees, ankles, other
(6) been limping or walking in a different way
(7) unable to participate in an activity because of joints
(9) had to cancel a daily activity because of joint problem
total score =
= (number of items present)
Interpretation:
• minimum score: 0
• maximum score: 12
• A score >= 5 indicates a pediatric patient who should be referred to a rheumatologist.
Purpose: To ask the parent of a pediatric patient about joint complaints that indicate the need to refer the patient to a rheumatologist.
Specialty: Immunology/Rheumatology, Surgery, orthopedic, Infectious Diseases
Objective: clinical diagnosis, including family history for genetics, laboratory tests, failure handling, when to refer
ICD-10: M08.0,