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Behçet's disease: evaluation of a new instrument to measure clinical activity
B B Bhakta1, P Brennan, T E James
1Rheumatology and Rehabilitation Research Unit, University of Leeds, UK.
Insights
The Behçet's disease current activity form shows good reliability for assessing disease activity. This tool can aid in routine monitoring and evaluating treatments for Behçet's disease patients.
Area of Science:
- Rheumatology
- Immunology
- Clinical Medicine
Background:
- Behçet's disease (BD) is a rare multisystem vasculitis with no reliable laboratory markers for disease activity.
- Clinical assessment is crucial for monitoring BD, necessitating reliable tools to measure disease activity.
Purpose of the Study:
- To evaluate the interobserver reliability of the BD Current Activity Form, a newly developed instrument for assessing disease activity.
Main Methods:
- Nineteen patients meeting International Study Group criteria for BD were independently assessed by five experienced physicians.
- Assessments included patient history and physical examination on the same day.
Main Results:
- Good interobserver agreement was found for oral ulceration (ICC=0.87), genital ulceration (ICC=0.95), headache (ICC=0.80), and eye involvement (ICC=0.77).
- Moderate agreement was observed for skin, arthritis, large vessel, and nervous system involvement.
- Poor agreement was noted for bloody diarrhea (ICC=0.28), and significant bias was found in fatigue rating by one physician.
Conclusions:
- The BD Current Activity Form demonstrates good interobserver reliability for general disease activity assessment.
- This instrument is suitable for routine clinical monitoring of Behçet's disease patients and for assessing outcomes in clinical trials.
Objective:
Behçet's disease (BD) is a rare multisystem disorder characterized by vasculitis. At present, there are no laboratory markers that correlate well with the clinical activity in BD. This has led to the development of an instrument (BD Current Activity Form) to measure activity. Scoring is based on the history of new clinical features present over the preceding 4 weeks prior to assessment. Standardized questions were developed for all parts of the form. The face validity of the proforma was determined following worldwide collaboration with physicians and ophthalmologists managing patients with BD. The aim of this study was to evaluate the interobserver reliability of this form.
Methods:
Nineteen patients fulfilling the International Study Group criteria for BD were randomly allocated, questioned and examined independently on the same day by five physicians experienced in BD.
Results:
There was good agreement between the physicians' rating of oral [intraclass correlation coefficient (ICC) = 0.87] and genital (ICC = 0.95) ulceration, skin involvement (ICC = 0.62 for pustules and ICC = 0.66 for erythema nodosum), arthritis (ICC = 0.62), headache (ICC = 0.80), large vessel (kappa = 0.53), nervous system (kappa = 0.61) and eye involvement (kappa = 0.77). There was poor agreement for the question relating to the presence of bloody diarrhoea (ICC = 0.28). There was significant bias in the rating of fatigue by one of the physicians (F = 5.2, P = 0.001).
Conclusion:
Overall, this instrument has good interobserver reliability for assessing general disease activity. We therefore suggest that this proforma has a place in routine clinical monitoring of patients with BD, as well as assessing outcome in therapeutic trials.