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ter Haar NM, van Delft ALJ, Annink KV, van Stel H, Al-Mayouf SM, Amaryan G, Anton J, Barron KS, Benseler S, Brogan PA, Cantarini L, Cattalini M, Cochino AV, de Benedetti F, Dedeoglu F, de Jesus AA, Demirkaya E, Dolezalova P, Durrant KL, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman HM, Insalaco A, Jansson AF, Kallinich T, Kone-Paut I, Kozlova A, Kuemmerle-Deschner JB, Lachmann HJ, Laxer RM, Martini A, Nielsen S, Nikishina I, Ombrello AK, Özen S, Papadopoulou-Alataki E, Quartier P, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Ravelli A, Schulert G, Gattorno M, Frenkel J. In silico validation of the Autoinflammatory Disease Damage Index. Ann Rheum Dis 2018; 77:1599-1605. [PMID: 30077992 PMCID: PMC8411437 DOI: 10.1136/annrheumdis-2018-213725] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 06/22/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
Introduction Autoinflammatory diseases can cause irreversible tissue damage due to systemic inflammation. Recently, the Autoinflammatory Disease Damage Index (ADDI) was developed. The ADDI is the first instrument to quantify damage in familial Mediterranean fever, cryopyrin-associated periodic syndromes, mevalonate kinase deficiency and tumour necrosis factor receptor-associated periodic syndrome. The aim of this study was to validate this tool for its intended use in a clinical/research setting. Methods The ADDI was scored on paper clinical cases by at least three physicians per case, independently of each other. Face and content validity were assessed by requesting comments on the ADDI. Reliability was tested by calculating the intraclass correlation coefficient (ICC) using an ‘observer-nested-within-subject’ design. Construct validity was determined by correlating the ADDI score to the Physician Global Assessment (PGA) of damage and disease activity. Redundancy of individual items was determined with Cronbach’s alpha. Results The ADDI was validated on a total of 110 paper clinical cases by 37 experts in autoinflammatory diseases. This yielded an ICC of 0.84 (95% CI 0.78 to 0.89). The ADDI score correlated strongly with PGA-damage (r=0.92, 95% CI 0.88 to 0.95) and was not strongly influenced by disease activity (r=0.395, 95% CI 0.21 to 0.55). After comments from disease experts, some item definitions were refined. The interitem correlation in all different categories was lower than 0.7, indicating that there was no redundancy between individual damage items. Conclusion The ADDI is a reliable and valid instrument to quantify damage in individual patients and can be used to compare disease outcomes in clinical studies.
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Affiliation(s)
- Nienke M ter Haar
- Laboratory for Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Paediatric Immunology and Rheumatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Kim Valerie Annink
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Henk van Stel
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
| | - Sulaiman M Al-Mayouf
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gayane Amaryan
- National Paediatric Centre for Familial Mediterranean Fever and Gastroenterology Service, Arabkir Medical Centre–Institute of Child and Adolescent Health, Yerevan, Armenia
| | - Jordi Anton
- Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Karyl S Barron
- Division of Intramural Research and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Susanne Benseler
- Departments of Paediatrics and Rheumatology, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Paul A Brogan
- Department of Infection, Inflammation and Rheumatology, University College London Institute of Child Health, London, UK
| | - Luca Cantarini
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Marco Cattalini
- Paediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Alexis-Virgil Cochino
- Department of Paediatrics, National Institute for Mother and Child Health Alessandrescu-Rusescu, Bucharest, Romania
| | | | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erkan Demirkaya
- Western University Children’s Hospital, London Health Sciences Centre, London, UK
| | - Pavla Dolezalova
- Department of Paediatrics and Adolescent Medicine, Charles University, General University Hospital, Praha, Czech Republic
| | | | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Romina Gallizzi
- Department of Paediatric Rheumatology, AOUG Martino, Messina, Italy
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | - Veronique Hentgen
- Reference Centre for Autoinflammatory Diseases (CEREMAI), Versailles Hospital, Le Chesnay, France
| | - Troels Herlin
- Departmentof Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Michaël Hofer
- Department of Paediatric Rheumatology, University of Lausanne, Lausanne, Switzerland
- Departmentof Paediatric Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Hal M Hoffman
- Department of Paediatrics, University of California, San Diego, California, USA
| | - Antonella Insalaco
- Dipartimento di Medicina Pediatrica, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Annette F Jansson
- Paediatric Pneumology and Immunology and Interdisciplinary Centre for Social Paediatrics, Charite University Medicine Berlin, Berlin, Germany
- Department of Rheumatology and Immunology, Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Tilmann Kallinich
- Paediatric Pneumology and Immunology and Interdisciplinary Centre for Social Paediatrics, Charite University Medicine Berlin, Berlin, Germany
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology and CEREMAI, Bicêtre Hospital, APHP, University of Paris Sud, Paris, France
| | - Anna Kozlova
- Department of Immunology, Federal Research and Clinical Centre for Paediatric Haematology, Oncology and Immunology, Moscow, Russian Federation
| | | | | | - Ronald M Laxer
- Department of Paediatrics and Medicine, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genova, Liguria, Italy
| | - Susan Nielsen
- Paediatric Rheumatology Unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Irina Nikishina
- Department of Paediatric Rheumatic Diseases, VA Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
| | - Amanda K Ombrello
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Seza Özen
- Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | | | - Pierre Quartier
- Department of Paediatric Immunology–Hematology and Rheumatology Unit and IMAGINE Institute, Institution Necker-Enfants Malades Hospital and Paris Descartes University, Paris, Île-de-France, France
| | - Donato Rigante
- Institute of Paediatrics, Fondazione Policlinico Universitario A Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Ricardo Russo
- Servicio de Inmunología/Reumatología, Hospital de Pediatria Juan P Garrahan, Buenos Aires, Argentina
| | - Anna Simon
- Department of General Internal Medicine, Radboud Expertise Centre for Immunodeficiency and Autoinflammation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maria Trachana
- Paediatric Immunology and Rheumatology Referral Centre, First Paediatric Clinic, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Yosef Uziel
- Department of Paediatrics, Meir Medical Centre, Kfar Saba, Israel
| | - Angelo Ravelli
- Institution Università degli Studi di Genova and G Gaslini Institute, Genova, Italy
| | - Grant Schulert
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Marco Gattorno
- Institution Università degli Studi di Genova and G Gaslini Institute, Genova, Italy
| | - Joost Frenkel
- Department of Paediatrics, Universitair Medisch Centrum Utrecht–Locatie Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands
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