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Connective Tissue Disease (CTQ)
The Connective Tissue Disease Screening Questionnaire (CSQ) is a highly reproducible, sensitive, and moderately specific instrument for screening subjects with potential Connective Tissue Disease (CTD).
Background
The CSQ was developed in English and translated to Dutch. It has 30 items and can be completed within 30 minutes.
For all intended purposes a person who does not meet the CTD criteria by the CSQ, as described below, does not have a CTD. The instrument can be used to identify a smaller group for subsequent detailed, specific examination. It should prove useful in population studies of the incidence, prevalence, and etiology of CTDs1). An algorithm for identifying potential CTD based on the ACR or published clinical criteria was used.
| CTD | Diagnostic criteria |
|---|---|
| Rheumatoid Arthritis (4 out of 6 criteria) | swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints for more than 6 weeks |
| swelling of three or more joints for more than 6 weeks | |
| swelling of wrist, metacarpophalangeal, or proximal interphalangeal joints for more than 6 weeks | |
| symmetric joint swelling | |
| rheumatoid nodules | |
| positive test result for rheumatoid factor. | |
| X-ray findings were not ascertained. | |
| Lupus (SLE) (4 out of 11 criteria) | malar rash |
| discoid rash | |
| photosensitivity | |
| oral ulcers | |
| arthritis | |
| serositis | |
| proteinuria | |
| hematologic disorder (anemia, leukopenia, low platelet count) | |
| positive antinuclear antibody (ANA) titer | |
| alopecia and Raynaud’s phenomenon* | |
| seizures and psychosis were excluded* | |
| Scleroderma (1 major or 2> minor criteria) | major: skin thickening proximal to the metacarpophalangeal joints |
| minor: sclerodactyly, digital pitting scars or loss of substance from the finger pad | |
| minor: pulmonary fibrosis | |
| polymyositis or dermatomyositis (2 out of 4 criteria) | muscle weakness for more than 3 months |
| upper extremity proximal muscle weakness for more than 3 months | |
| lower extremity proximal muscle weakness for more than 3 months | |
| a history of an elevated muscle enzyme level (creatinine phosphokinase) | |
| electromyography and muscle biopsy results were not ascertained. | |
| Sjögren's syndrome (1 of 2 criteria) | dry eyes and dry mouth |
| positive serologic test results (ANA or rheumatoid factor) plus dry eyes or dry mouth | |
| lip biospy, Rose-bengal staining, and Schirmer’s test results were not ascertained. | |
| Raynaud’s phenomenon | cold sensitivity plus white, blue, or purple color changes of the fingers on exposure to cold |
| Mixed connective tissue disease (4 out of 5 criteria) | synovitis as defined by the RA algorithm (see above) |
| hand edema | |
| Raynaud’s phenomenon (see above) | |
| myositis as defined by the polymyositis/dermatomyositis algorithm (see above) | |
| acrosclerosis |
*Alopecia and Raynaud’s phenomenon were demonstrated by Tan and colleagues to have good sensitivity for SLE but lower specificity in distinguishing SLE from other CTDs. These were included because the goal of our study was to develop a highly sensitive instrument for detecting any CTD.
*Seizures and psychosis were not included because of their relatively low sensitivity (12 and
13%, respectively) in the study by Tan and colleagues.
Results of tests for immunologic disorders, anti-Smith (Sm) antibody, anti-double stranded DNA (dsDNA) antibody, and false positive serologic test for syphilis were not ascertained by questionnaire because we thought that most patients would not know the results of these laboratory tests.
