Rheumatoid arthritis of [joint structure] (disorder) - v1.0

Hello Bruce Goldberg

Remodeled RA as discussed at ECE meeting Monday 22nd Feb, and separated the template into two templates (1) Rheumatoid arthritis and (2) Extra articular manifestations of rheumatoid arthritis.

Nicki

Hi Nicki. I would remove the causative agent relationship. RF is not a cause of RA. The cause of RA is unknown.

Bruce

Bruce Goldberg Agree - added for >>239791005 |Seropositive rheumatoid arthritis (disorder)| but these will be remodelled.

Hi Nicola Ingram,  69896004 |Rheumatoid arthritis (disorder)| is primitive. Should it be the proximal primitive parent in this template?

The causative agent has been removed from the template language to align with the model. [[~0..1]] 246075003 |Causative agent (attribute)| = (77089006 |Rheumatoid factor (substance)|).

The format and value for cardinalities have been updated. The value has been restricted to identify potential issues for the QI project. The support for multiple role groups will be supported in the Authoring platform. 

An additional rule 'item d' is added for seronegative/seropositive.  I am not sure if 'item e' for descriptions is relevant to this template. Please let me know if any further changes are needed for this template. 

Thanks Yongsheng Gao - for your question yes 69896004 |Rheumatoid arthritis (disorder)| is is the proximal primitive parent in this template I believe RA cannot be defined based on current knowledge and the complexity of RA itself. You are right rule e does not apply for this Template - I will remove it. 

In your opinion is it clear from the way that I have worded the description that the Sero[range] wording only applies to the Seronegative RA and Seropositive RA?

cc Bruce Goldberg

Yongsheng Gaono further changes from me

cc Bruce Goldberg

This is still a little confusing. Currently, in the daily build brower, Rheumatoid arthritis is still modeled as a kind of arthritis so including Extra-articular rheumatoid process as a subtype does not make sense to me and which is why I originally advocated for moving the latter from under RA. On the other hand, If we mean Rheumatoid arthritis (disorder) to signify both joint disease and extra-articular manifestations then a simple soultion is to remove the finding site of joint structure from Rheumatoid arthritis (disorder) and just use joint structure for concepts specifying a joint such as RA of hand or for manifestations of RA which we had concluded mostly always include joint involvement. 

Also, Why is the occurrence relationship needed?

Bruce

Hi Yongsheng Gao Bruce Goldberg

Agree with Yong’s recollection of our decision re 52661003 |Extra-articular rheumatoid process (disorder)|
…but the same problem still exists a disorder known everywhere as arthritis and that is/can be an arthritis of the joint is in fact systemic and extra-articular.

I have tried this GCI solution:

1. Removed rheumatoid disease as a synonym of 69896004 |Rheumatoid arthritis (disorder)|
2. Created a new concept Rheumatoid disease (disorder) ISA 56019007 |Systemic disease (disorder)|
3. Added 2 GCIs to Rheumatoid disease (disorder) – see screenshot
4. 69896004 |Rheumatoid arthritis (disorder)| renamed 69896004 |Rheumatoid arthritis of joint (disorder)|
5. Joint role group removed from 52661003 |Extra-articular rheumatoid process (disorder)|and some subtypes
6. Extra-articular rheumatoid process (disorder) moved out from under 69896004 |Rheumatoid arthritis (disorder)|

Have added you both to task to view - it does works .. not final but may be a first step!

Template looks good. I approve.

Bruce

Yongsheng GaoTemplate is ready for review - thanks.

Yongsheng GaoThere is juvenile and use of 255398004 |Childhood (qualifier value)| as in 10718002 |Juvenile myxedema (disorder)| and looking now it is stated on 75822003 |Acute polyarticular juvenile rheumatoid arthritis (disorder)| but the juvenile rheumatoid arthritis concepts are not aligning to the Template I will need to review them.

Nicki 

 Nicola Ingram, 

Yongsheng Gao

"Juvenile rheumatoid arthritis" should not classify under rheumatoid arthritis. It is an obsolete term for what is now referred to as juvenile idiopathic arthritis and which represents several distinct autoimmune arthropathies of childhood.

Bruce Goldberg are you happy for Yong to remove the occurrence in the Template?

At present 410795001 |Juvenile rheumatoid arthritis (disorder)| and subtypes do not classify under rheumatoid arthritis so all good at the moment but they do look as if they can be improved (not modeled as autoimmune).

Nicki

410795001 |Juvenile rheumatoid arthritis (disorder)| should be retired as outdated and point to 410502007 |Juvenile idiopathic arthritis (disorder)|. The subtypes of JIA (listed below) are all autoimmune.

• Oligoarthritis: Affects four or fewer joints, typically the large ones (knees, ankles, elbows). Most common subtype of JIA.
• Polyarthritis: Affects five or more joints, often on both sides of the body (both knees, both wrists, etc.). May affect large and small joints. Affects about 25% of children with JIA.
• Systemic: Affects the entire body (joints, skin and internal organs). Symptoms may include a high spiking fever (103°F or higher) that lasts at least two weeks and rash. Affects about 10% of children with JIA.
• Psoriatic arthritis (PsA): Joint symptoms and a scaly rash behind the ears and/or on the eyelids, elbows, knees, belly button and scalp. Skin symptoms may occur before or after joint symptoms appear. May affect one or more joints, often the wrists, knees, ankles, fingers or toes. 
• Enthesitis-related: Also known as spondyloarthritis. Affects where the muscles, ligaments or tendons attach to the bone (entheses). Commonly affects the hips, knees and feet, but may also affect the fingers, elbows, pelvis, chest, digestive tract (Crohn’s disease or ulcerative colitis) and lower back (ankylosing spondylitis). More common in boys; typically appears in children between the ages of eight and 15. 
• Undifferentiated: Symptoms don’t match up perfectly with any of the subtypes, but inflammation is present in one or more joints.  

Bruce GoldbergGreat - thanks - I'll do this remodeling in a task tomorrow and add you as reviewer.