New Haven Survey of Joint Disease

Acheson, R. M. (Dept. Epidemiology and Public Health, Yale Univ. School of Medicine, New Haven, Conn.), A. B. Collart, R. H. Greenberg and A. R. Clemett. New Haven survey of joint disease. Photographs and other variables in screening for arthritis of the hands. Amer. J. Epid., 1969, 90: 224–235.—The value of a symptom questionnaire and a standardized colored photograph of the hands as screening devices for osteoarthrosis in the hands is examined in a population of 1,013 adults in New Haven. These screening devices were used because they permit data both to be obtained in a house-to-house survey and to undergo initial evaluation by non-professional personnel. The screening procedures are validated against x-rays of the two hands read for osteoarthrosis on a joint by joint basis. A non-parametric discriminant function analysis based on the cross-classification of a discriminator with x-ray evidence of osteoarthrosis has shown that age was the most effective of the discriminators, while bony deformity as determined from hand photographs was second. The symptom of hand swelling and sign of muscular wasting seen in the photographs were also of some value. Assessments of false positive and false negative rates indicate that while age is about 89% sensitive, it is less than 69% specific. In contrast, bony deformity is about 80% specific but no more than 58% sensitive. Because our results are derived using a technique that maximizes the correct predictions in this study population, significance tests were not used to evaluate the hypothesis of chance as an explanation of these results; further, the non-random nature of the sample compromises any easy generalization of them. Encouragement was, however, taken from the fact that a physical sign detected from a photographs is a much more effective discriminator than any symptom, especially since experience with the technicalities of reading the photographs is presently limited.