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340. USING THE BIRMINGHAM VASCULITIS ACTIVITY SCORE (BVAS) TO SCREEN FOR VASCULITIS
Abstract
Background: The Birmingham Vasculitis Activity Score (BVAS) is a clinical assessment tool validated to assess disease activity in patients with systemic vasculitis. It allows clinical features to be represented as a numerical value which signifies disease activity. It has been widely used in clinical trials of vasculitis. A
modified version of the clinical tool (BVAS 2003) is currently being validated. BVAS has been used to screen for vasculitis in a limited study but its performance in patients with rheumatic presentations, not known to have vasculitis, has not been evaluated.
Methods: Patients not known to have systemic vasculitis but unwell due to other rheumatologic disorders were assessed using the BVAS and BVAS 2003. Both clinical tools require items to be scored only if they can be attributed to the presence of vasculitis. For this exercise, all items were scored regardless of attribution. We compared these findings with baseline data from patients with ANCA associated vasculitis who had been prospectively recruited into three large European Vasculitis Study group (EUVAS) clinical trials.
Results: 49 patients were recruited; 26 rheumatoid arthritis (RA), 4 reactive arthritis, 3 ankylosing spondylitis, 3 systemic lupus erythematosus (SLE), and 13 patients with other diagnoses. The mean scores for BVAS and BVAS 2003 were 5.54+/-�5.9 and 5.38�+/-6.24 respectively. 33/49 (67%) scored </=�5, and 40/49 (82%)
scored �</=10 (out of a maximum 63) on the BVAS. 35/49 (71%) scored �</=5 and 41/49 (84%) scored </=�10 on the BVAS 2003. BVAS and BVAS 2003 correlated well with each other (Spearman’s rank correlation coefficient �= 0.94). Reviewing the 9 patients with a BVAS >10, 2 of them had definite vasculitis (1 Wegener’s
granulomatosis, 1 rheumatoid vasculitis), 1 had probable vasculitis (WG), 2 patients had SLE and 4 patients did not have evidence of vasculitis. A BVAS>10 as a screening tool has a 33% chance of picking up occult vasculitis. 2/9 patients (1 SLE and 1 RA) who scored >10 on BVAS, died within 6 months of their assessment, supporting previous evidence of poor prognosis associated with high BVAS values in vasculitis. Comparing this data with the entry BVAS in 341 patients in EUVAS clinical trials, a BVAS�10 is 90% sensitive and 87% specific for a diagnosis of vasculitis.
Conclusions: A BVAS>10 is highly sensitive and specific for a diagnosis of vasculitis and can be used to screen for vasculitis in rheumatology patients. BVAS and BVAS 2003 scores correlated well in these patients.
... In this case the patient scored 18 points out of a maximum 64, indicating a good prognosis. Ball et al (2014) reported that the value of this tool lies only with GPA, rendering it ineffectual to the entirety of the vasculitides, whereas Mukhtyar and Luqmani (2008) found a BVAS greater than 10 was 90% sensitive and 87% specific for a diagnosis of vasculitis, representing it as a highly effective screening tool. For nurses with an awareness of different classifications, and who understand the full systemic involvement of vasculitis, the BVAS allows them to assist specialists in monitoring disease activity. ...
Vasculitis is a relatively rare and poorly understood condition causing inflammation of the blood vessels, which in turn can affect a patient's respiratory and renal systems. In some cases, ocular involvement can cause loss of sight and hearing loss may also be a red flag for vasculitis, which, if not treated early, can cause complete hearing loss. Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is a group comprising granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis (EGP). AAV is fatal if untreated and as increased risk escalates with age, coupled with a decline in renal function, these are the principal predictors of poor outcome. Vital roles for nursing vasculitis patients lie in managing inflammation and pain, as these distressing symptoms are prevalent in the disease. Because of the multiple complications that can occur with vasculitis, treatment-related information is a high priority for these patients. As nurses are well placed to deliver information, value lies in their role in reducing the negative impacts on treatment regimens and compliance that accompany patients' poor insight into their condition.
Background: The Birmingham Vasculitis Activity Score is a clinical tool to quantify disease activity in systemic vasculitis. Following its extensive use, a previous version of BVAS has been revised to improve the face validity and the feasibility. Changes were made and approved by an expert committee. Objective: To validate the third version of the Birmingham Vasculitis Activity Score (BVAS version 3) Methods: In a series of prospective, multi-centre studies, different aspects of the BVAS (version 3) were validated in patients with systemic vasculitis. The data collection was done using standardized data entry forms. The studies were approved by local ethics committees. The recruitment of controls was approved by the local clinical audit and effectiveness department. Results: The convergent validity was established by correlating the BVAS (version 3) to the physician’s treatment decision (Spearman's ρ 0.66, 95% CI 0.59-0.72), BVAS1 of version 2 (ρ 0.94, 95% CI 0.92-0.96), BVAS2 of version 2 in patients with persistent disease (ρ 0.60, 95% CI 0.21-0.83), C-reactive protein levels (�� 0.43, 95% CI 0.31-0.54), physician's global assessment (ρ 0.91, 95% CI 0.89-0.93), and vasculitis activity index (ρ 0.88, 95%CI 0.86-0.91). The BVAS (version 3) was reproducible and repeatable (intra-class correlation coefficients were 0.96 (95%CI 0.95-0.97) and 0.96 (95%CI 0.92-0.97) respectively). The BVAS (version 3) was sensitive to changing disease status with a fall of 16.9 (95% CI 14.8-18.9) units (P<0.001, paired t test) after 3 months of treatment. The BVAS (version 3) demonstrated an ability to differentiate systemic vasculitis from some non-vasculitis conditions. Conclusion: BVAS (version 3) is validated for use in clinical trials of systemic vasculitis. It is repeatable, reproducible, sensitive to change and can differentiate between systemic vasculitis and some non-vasculitic rheumatological conditions.
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