作为巨细胞动脉炎患者疾病活动度衡量指标的伯明翰血管炎活动评分
The Birmingham Vasculitis Activity Score as a Measure of Disease Activity in Patients with Giant Cell Arteritis.
作者信息
Kermani Tanaz A, Cuthbertson David, Carette Simon, Hoffman Gary S, Khalidi Nader A, Koening Curry L, Langford Carol A, McKinnon-Maksimowicz Kathleen, McAlear Carol A, Monach Paul A, Seo Philip, Warrington Kenneth J, Ytterberg Steven R, Merkel Peter A, Matteson Eric L
机构信息
From the Division of Rheumatology, University of California, Los Angeles, Los Angeles, California; Department of Biostatistics, University of South Florida, Tampa, Florida, USA; Division of Rheumatology, Mount Sinai Hospital, Toronto, Ontario, Canada; Center for Vasculitis Care and Research, Cleveland Clinic, Cleveland, Ohio, USA; Division of Rheumatology, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada; Division of Rheumatology, University of Utah, Salt Lake City, Utah; Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Rheumatology and Clinical Immunology, University of Pennsylvania, Philadelphia, Pennsylvania; The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts; Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland; Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.T.A. Kermani, MD, MS, Division of Rheumatology, University of California, Los Angeles; D. Cuthbertson, MS, Department of Biostatistics, University of South Florida; S. Carette, MD, FRCPC, Division of Rheumatology, Mount Sinai Hospital; G.S. Hoffman, MD, MS, Center for Vasculitis Care and Research, Cleveland Clinic; N.A. Khalidi, MD, FRCPC, Division of Rheumatology, St. Joseph's Healthcare, McMaster University; C.L. Koening, MD, MS, Division of Rheumatology, University of Utah; C.A. Langford, MD, MHS, Center for Vasculitis Care and Research, Cleveland Clinic; K. McKinnon-Maksimowicz, DO, Division of Rheumatology, University of Pittsburgh; C.A. McAlear, MA, Division of Rheumatology and Clinical Immunology, University of Pennsylvania; P.A. Monach, MD, PhD, The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine; P. Seo, MD, MHS, Division of Rheumatology, Johns Hopkins University; K.J. Warrington, MD, Division of Rheumatology, Mayo Clinic
出版信息
J Rheumatol. 2016 Jun;43(6):1078-84. doi: 10.3899/jrheum.151063. Epub 2016 Apr 1.
OBJECTIVE
To evaluate the performance of the Birmingham Vasculitis Activity Score (BVAS) in the assessment of disease activity in giant cell arteritis (GCA).
METHODS
Patients with GCA enrolled in a prospective, multicenter, longitudinal study with symptoms of active vasculitis during any visit were included. Spearman's rank correlation was used to explore the association of the BVAS with other measures of disease activity.
RESULTS
During a mean (SD) followup of 2.3 (1.6) years, symptoms of active GCA were present in 236 visits in 136 subjects (100 female, 74%). Median (range) BVAS1 (new/worse symptoms) was 1 (0-10) and median (range) BVAS2 (persistent symptoms) was 0 (0-5). Median (range) physician's global assessment (PGA) was 4 (0-9) for disease activity in the past 28 days and 2 (0-9) for activity on the day of the visit. Important ischemic manifestations of active vasculitis not recorded by the BVAS included tongue/jaw claudication (27%), upper extremity claudication (15%), lower extremity claudication (5%), carotidynia (7%), and ischemic retinopathy (5%). During 25 visits (11%) with active disease, all symptoms of active vasculitis were placed in the "Other" category yet still resulted in a BVAS1 and BVAS2 of 0. BVAS1 moderately correlated with PGA for the past 28 days (Spearman's correlation 0.50) and physician-rated disease activity for the past 28 days (Spearman's correlation 0.46).
CONCLUSION
The BVAS has limited utility in GCA. Patients with active GCA can have a BVAS of 0. Many important ischemic symptoms attributable to active vasculitis are not included in the composite score.
目的
评估伯明翰血管炎活动评分（BVAS）在巨细胞动脉炎（GCA）疾病活动度评估中的表现。
方法
纳入参加一项前瞻性、多中心、纵向研究的GCA患者，这些患者在任何一次就诊时均有活动性血管炎症状。采用Spearman等级相关分析来探究BVAS与其他疾病活动度指标之间的关联。
结果
在平均（标准差）2.3（1.6）年的随访期间，136例受试者出现236次活动性GCA症状（100例女性，占74%）。BVAS1（新出现/加重症状）的中位数（范围）为1（0 - 10），BVAS2（持续性症状）的中位数（范围）为0（0 - 5）。在过去28天内，医生整体评估（PGA）的疾病活动度中位数（范围）为4（0 - 9），就诊当天活动度的中位数（范围）为2（0 - 9）。BVAS未记录的活动性血管炎重要缺血表现包括舌/颌跛行（27%）、上肢跛行（15%）、下肢跛行（5%）、颈动脉痛（7%）和缺血性视网膜病变（5%）。在25次（11%）活动性疾病就诊中，所有活动性血管炎症状均被归为“其他”类别，但BVAS1和BVAS2仍为0。BVAS1与过去28天的PGA中度相关（Spearman相关系数为0.50），与过去28天医生评定的疾病活动度中度相关（Spearman相关系数为0.46）。
结论
BVAS在GCA中的效用有限。活动性GCA患者的BVAS可能为0。综合评分未纳入许多由活动性血管炎引起的重要缺血症状。
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