Validation of English and Spanish-Language Versions of a Screening Questionnaire for Rheumatoid Arthritis in an Underserved Community

JEFFREY POTTER, JENNIFER ODUTOLA, CHRISTIAN AMURRIO GONZALES, and MICHAEL M. WARD

ABSTRACT.

Objective. Questionnaires to screen for rheumatoid arthritis (RA) have been tested in groups that were primarily well educated and Caucasian. We sought to validate the RA questions of the Connective Tissue Disease Screening Questionnaire (CSQ) in ethnic minorities in an underserved community, and to test a Spanish-language version.

Methods. The Spanish-language version was developed by 2 native speakers. Consecutive English-speaking or Spanish-speaking patients in a community-based rheumatology practice completed the questionnaire. Diagnoses were confirmed by medical record review. Sensitivity and specificity of the questionnaire for a diagnosis of RA were computed for each language version, using 2 groups as controls: patients with noninflammatory conditions, and participants recruited from the community.

Results. The English-language version was tested in 53 patients with RA (79% ethnic minorities; mean education level 11.3 yrs), 85 rheumatology controls with noninflammatory conditions, and 82 community controls. Using 3 positive responses as indicating a positive screening test, the sensitivity of the questionnaire was 0.77, the specificity based on rheumatology controls was 0.45, and the specificity based on community controls was 0.94. The Spanish-language version was tested in 55 patients with RA (mean education level 7.8 yrs), 149 rheumatology controls, and 88 community controls. The sensitivity of the Spanish-language version was 0.87, with specificities of 0.60 and 0.97 using the rheumatology controls and community controls, respectively.

Conclusion. The sensitivity of the English-language version of the RA questions of the CSQ was lower in this study than in other cohorts, reflecting differences in the performance of the questions in different ethnic or socioeconomic groups. The Spanish-language version demonstrated good sensitivity, and both had excellent specificity when tested in community controls. (First Release June 15 2008; J Rheumatol 2008;35:1545–9)

Key Indexing Terms:

RHEUMATOID ARTHRITIS
SCREENING
SPANISH LANGUAGE

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From the Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.

Supported by the Intramural Research Program of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health.

J. Potter, MD; J. Odutola, MD, MS; C.A. Gonzales, MD; M.M. Ward, MD, MPH.

Address reprint requests to Dr. M.M. Ward, NIH/NIAMS/IRP, Building 10 CRC, Room 4-1339, 10 Center Drive, MSC 1468, Bethesda, MD 20892-1468. E-mail: wardm1@mail.nih.gov

Accepted for publication March 12, 2008.

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