Clinical Tools

Birmingham Vasculitis Activity Score

The Birmingham Vasculitis Activity Score (BVAS) is a validated clinical tool to quantify disease activity in patients with systemic vasculitis. It has been internationally adopted and used by most research groups involved in clinical trials in vasculitis.

The 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.

The use of BVAS requires prior training. A training manual is available online at the website of the European Vasculitis Study Group. Even without the training the BVAS is a good aide memoire of the clinical manifestations that need to be looked for at each follow up visit for patients with systemic vasculitis.

BVAS eform button

This is a Microsoft Excel programme of the current version of the BVAS. The e-form will automatically calculate the activity. Macros will need to be enabled on the user computer for the calculator to function.

Mukhtyar, C., Lee, R., Brown, D., Carruthers, D., Dasgupta, B., Dubey, S., Flossmann, O., Hall, C., Hollywood, J., Jayne, D., Jones, R., Lanyon, P., Muir, A., Scott, D., Young, L. and Luqmani, R. A. (2009). “Modification and validation of the Birmingham Vasculitis Activity Score (version 3).” Ann Rheum Dis 68(12): 1827-32.

Prednisolone regimen for giant cell arteritis and polymyalgia rheumatica

GCA and PMR button

This is a downloadable Microsoft Excel based calculator of the regimen used by the Rheumatology department. This regimen has not been validated in any clinical trial, but it is the nearest that we can come to an evidence based regimen. The evidence base for this regimen is derived from several sources referenced below.

The Microsoft Excel programme has separate sheets for PMR and GCA. After selecting the appropriate sheet, enter the patient’s details, weight and date of starting prednisolone treatment. These are the only things that you will be able to modify. The suggested regimen will modify if the patient weighs less than 60 kg. You can round off the regimen to a more practical dosing in the currently empty column “Prednisolone dose in mg/day”. The actual cumulative dose will reflect your actual prednisolone use. You can compare this with the suggested cumulative dose to audit the actual regimen.

Dasgupta, B., Borg, F. A., Hassan, N., Alexander, L., Barraclough, K., Bourke, B., Fulcher, J., Hollywood, J., Hutchings, A., James, P., Kyle, V., Nott, J., Power, M. and Samanta, A. “BSR and BHPR guidelines for the management of giant cell arteritis.” Rheumatology (Oxford) 49(8): 1594-7.
Hunder, G. G., Sheps, S. G., Allen, G. L. and Joyce, J. W. (1975). “Daily and alternate-day corticosteroid regimens in treatment of giant cell arteritis: comparison in a prospective study.” Ann Intern Med 82(5): 613-8.
Mazlumzadeh, M., Hunder, G. G., Easley, K. A., Calamia, K. T., Matteson, E. L., Griffing, W. L., Younge, B. R., Weyand, C. M. and Goronzy, J. J. (2006). “Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial.” Arthritis Rheum 54(10): 3310-8.
Mukhtyar, C., Guillevin, L., Cid, M. C., Dasgupta, B., de Groot, K., Gross, W., Hauser, T., Hellmich, B., Jayne, D., Kallenberg, C. G., Merkel, P. A., Raspe, H., Salvarani, C., Scott, D. G., Stegeman, C., Watts, R., Westman, K., Witter, J., Yazici, H. and Luqmani, R. (2009). “EULAR recommendations for the management of large vessel vasculitis.” Ann Rheum Dis 68(3): 318-23.
Proven, A., Gabriel, S. E., Orces, C., O'Fallon, W. M. and Hunder, G. G. (2003). “Glucocorticoid therapy in giant cell arteritis: duration and adverse outcomes.” Arthritis Rheum 49(5): 703-8.