Kashin–Beck disease

Concordant osteoarticular pattern

Record symptoms, movement restriction, deformity and imaging findings separately before assessing agreement; published research has used explicit clinical case definitions. [Tibetan population study](https://www.nejm.org/doi/full/10.1056/NEJM199810153391604).

1. Which joints and skeletal regions show abnormalities, and how do examination and imaging agree? measurement
2. Which findings could instead be explained by trauma, inflammatory arthritis or another skeletal disorder? boundary

Versioned case assertion

Retain the issuing body, revision, applicable population and supporting observations for each diagnosis; resolve terminology mappings independently of the clinical decision.

1. Which issuing body and exact criteria revision support this diagnostic assertion? provenance
2. Which verified ICD-10, ICD-11 and SNOMED CT mappings identify this concept in the required editions? definition
3. Is this record a suspected case, an established diagnosis or only a screening observation? boundary

Developmental trajectory

Record onset estimates, serial growth and metaphyseal or epiphyseal observations without inferring childhood onset solely from adult deformity.

1. What evidence dates symptom onset and skeletal abnormalities relative to growth and skeletal maturity? provenance
2. How have height, body proportions and affected digits changed against an identified growth reference? measurement

Structural and functional state

Record structural grade under its own standard alongside pain, mobility and participation; do not use a severity grade as proof of ongoing progression.

1. Which dated observations demonstrate progression, stability or improvement? measurement
2. Which walking, hand-use or daily activities are limited, and which changes warrant clinical reassessment? action

Dated residence and supply history

Link childhood residence, food sourcing and water supply to contemporaneous local evidence rather than present-day address.

1. Where did the person live during growth, and what evidence describes disease occurrence there during those years? provenance
2. Which food or water exposures were measured directly, reported retrospectively or inferred from locality? boundary

Association versus causation

Keep selenium and iodine measurements separate from causal attribution; research has assessed these nutritional factors in affected Tibetan populations. [Population study](https://www.nejm.org/doi/full/10.1056/NEJM199810153391604).

1. Which nutritional or environmental factors have direct measurements, with specimen, method, units and date? measurement
2. Does the cited evidence establish association, an experimental effect or a causal mechanism, and what competing explanations remain? provenance

Bounded burden estimate

Require geography, observation year, age range, numerator, denominator, sampling method and diagnostic definition for every burden estimate.

1. What population, year and case definition produced this prevalence or incidence estimate? measurement
2. Were cases found through clinical screening, radiography or existing records, and who was missed? provenance

Cohort-specific surveillance signal

Interpret trends using onset evidence, age cohorts and changes in screening coverage or diagnostic criteria.

1. Does a newly reported case represent recent onset or delayed recognition of longstanding disease? boundary
2. Could migration, ageing, screening changes or revised criteria explain the apparent trend? provenance

Intervention context and endpoint

Record intervention composition, baseline nutritional status, comparator and endpoints. A Qinghai trial assessed grain replacement and selenium-iodine salt using new cases and radiographic outcomes. [Intervention trial](https://pubmed.ncbi.nlm.nih.gov/25252032/).

1. Did the study measure prevention of new cases, change in existing lesions or correction of nutrient deficiency? boundary
2. Which population differences, concurrent interventions and study limitations affect applicability here? action

Care target and response

Separate symptom relief, functional improvement and structural change. A Tibetan trial found no added benefit of selenium for established disease after iodine correction, limiting assumptions that supplementation reverses damage. [Randomized trial](https://pubmed.ncbi.nlm.nih.gov/12816783/).

1. Is the proposed action intended to address deficiency, pain, mobility, deformity or another explicit target? action
2. What clinician-reviewed evidence supports rehabilitation, medication or surgical assessment for this person's impairment? provenance
3. Which baseline and follow-up measures will establish benefit, adverse effects or need to change the care plan? measurement

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these check these first hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these identifiers and schemes hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Standards and regulation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these standards and regulation hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these real-world use hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these failure modes and hazards hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these regional variation hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of Kashin-Beck disease this model covers, and on what evidence? provenance