Assessment of disease activity, damage and function in systemic vasculitis is an essential component of EUVAS' clinical trials. It provides the clinical basis for decision making regarding therapy and allows to compare different groups of patients treated at different centres but using similar protocols in order to be able to compare different treatments. The qualitative and quantitative information obtained may form the basis of individual patient evaluation for long-term patient care and may additionally be of help in determining prognosis or outcome. Disease evaluation of vasculitis is a natural extension to the normal clinical care of patients with multisystem conditions.
The Birmingham Vasculitis Activity Score (BVAS) and the Vasculitis Damage Index (VDI) have been adopted and used by most research groups involved in clinical trials in vasculitis. BVAS and VDI are internationally recognised assessment tools allowing comparison of studies from different continents and effective collaboration in multi-centre studies. Clinical trials using these tools have, for the first time, provided a firm evidence base for treatment decisions in this life-threatening group of conditions.
The Birmingham Vasculitis Activity Score (BVAS) form is divided into 9 organ-based systems, with each section including symptoms/signs that are typical of that particular organ involvement in systemic vasculitis. The clinician only scores features believed to be due to active vasculitis. Completion of the form provides a numerical score. The BVAS form was first published in 1994. Over the past years, there have been a number of changes to further improve the assessment form. Consequently, a newer version has been developed called BVAS V3.0.
The Vasculitis Damage Index (VDI) is divided into 11 organ systems and records items of damage, due to vasculitis, treatment or unrelated, that have occurred since the onset of vasculitis. Completion of the form provides a numerical score. The VDI was first published in 1997. A revised version of this tool called Combined Damage Assessment Index (CDA) is currently being developed.
A comprehensive overview of clinical evaluation of vasculitis and the development of BVAS and VDI was published in the Annals of Rheumatic Diseases in 2007.
At first glance there may appear to be a lot of complexities to the evaluation forms, but these reflect the normal every day practice of many clinicians who deal with patients with systemic vasculitis. Because of these complexities a dedicated website is available for training and certification. Training is required in order to use the forms properly. There are separate forms of BVAS V3. with this glossary, as well as of VDI. BVAS 3.0 and VDI are availalbe as a convenient two-page document.