The Birmingham Vasculitis Activity Score (BVAS) is a clinical index of disease activity for patients with vasculitis. It uses a weighted score to measure changes in the patient's condition over the previous 4 weeks. It can be used to monitor a patient's response to therapeutic interventions and to determine if further therapy is needed. The score was developed at the University of Birmingham in England.
Components to the BVAS:
(1) systemic findings
(2) cutaneous
(3) mucous membranes/eyes
(4) ENT (ears, nose, throat)
(5) chest
(6) cardiovascular
(7) abdominal
(8) renal
(9) nervous system
Criteria for scoring:
(1) newly present or worsening
(2) during the previous past 4 weeks
(3) ascribable to vasculitis
Systemic
|
Parameter |
Finding |
Points |
|---|---|---|
|
malaise |
no |
0 |
|
|
yes |
1 |
|
myalgia |
no |
0 |
|
|
yes |
1 |
|
arthralgia/arthritis |
no |
0 |
|
|
yes |
1 |
|
fever |
none |
0 |
|
|
present but < 38.5°C |
1 |
|
|
present and >= 38.5°C |
2 |
|
weight loss |
none |
0 |
|
|
< 1 kg |
0 |
|
|
1-2 kg in past month |
2 |
|
|
> 2 kg in past month |
3 |
subscore for systemic findings =
= MIN(3, SUM(points for parameters))
Cutaneous
|
Parameter |
Finding |
Points |
|---|---|---|
|
infarct |
no |
0 |
|
|
yes |
2 |
|
purpura |
no |
0 |
|
|
yes |
2 |
|
other skin vasculitis |
no |
0 |
|
|
yes |
2 |
|
ulcer |
no |
0 |
|
|
yes |
4 |
|
gangrene |
none |
0 |
|
|
present |
6 |
|
|
multiple digit gangrene |
6 |
subscore for cutaneous =
= MIN(6, SUM(points for parameters))
Mucous Membranes/Eyes
|
Parameter |
Finding |
Points |
|---|---|---|
|
mouth ulcers |
no |
0 |
|
|
yes |
1 |
|
genital ulcers |
no |
0 |
|
|
yes |
1 |
|
conjunctivitis |
no |
0 |
|
|
yes |
1 |
|
epi/scleritis |
no |
0 |
|
|
yes |
2 |
|
uveitis |
no |
0 |
|
|
yes |
6 |
|
retinal exudates |
no |
0 |
|
|
yes |
6 |
|
retinal hemorrhage |
no |
0 |
|
|
yes |
6 |
subscore for mucous membranes/eye =
= MIN(6, SUM(points for parameters))
ENT
|
Parameter |
Finding |
Points |
|---|---|---|
|
nasal discharge or obstruction |
no |
0 |
|
|
yes |
2 |
|
sinusitis |
no |
0 |
|
|
yes |
2 |
|
epistaxis |
no |
0 |
|
|
yes |
4 |
|
crusting |
no |
0 |
|
|
yes |
4 |
|
aural discharge |
no |
0 |
|
|
yes |
4 |
|
otitis media |
no |
0 |
|
|
yes |
4 |
|
new deafness |
no |
0 |
|
|
yes |
6 |
|
hoarseness/laryngitis |
no |
0 |
|
|
yes |
2 |
|
sublgottic involvement |
no |
0 |
|
|
yes |
6 |
subscore for ENT =
= MIN(6, SUM(points for parameters))
Chest
|
Parameter |
Finding |
Points |
|---|---|---|
|
dyspnea or wheeze |
no |
0 |
|
|
yes |
2 |
|
nodules or fibrosis |
no |
0 |
|
|
yes |
2 |
|
pleural effusion/pleuritis |
no |
0 |
|
|
yes |
4 |
|
infiltrate |
no |
0 |
|
|
yes |
4 |
|
hemorrhage/hemoptysis |
no |
0 |
|
|
present |
4 |
|
|
massive |
6 |
subscore for chest =
= MIN(6, SUM(points for parameters))
Cardiovascular
|
Parameter |
Finding |
Points |
|---|---|---|
|
bruits |
no |
0 |
|
|
yes |
2 |
|
new loss of pulses |
no |
0 |
|
|
yes |
4 |
|
aortic incompetence |
no |
0 |
|
|
yes |
4 |
|
pericarditis |
no |
0 |
|
|
yes |
4 |
|
new myocardial infarct |
no |
0 |
|
|
yes |
6 |
|
congestive cardiac failure (CCF) / cardiomyopathy |
no |
0 |
|
|
yes |
6 |
subscore for cardiovascular =
= MIN(6, SUM(points for parameters))
Abdominal
|
Parameter |
Finding |
Points |
|---|---|---|
|
abdominal pain |
no |
0 |
|
|
yes |
3 |
|
bloody diarrhea |
no |
0 |
|
|
yes |
6 |
|
gallbladder perforation |
no |
0 |
|
|
yes |
9 |
|
gut infarction |
no |
0 |
|
|
yes |
9 |
|
pancreatitis |
no |
0 |
|
|
yes |
9 |
subscore for abdominal =
= MIN(9, SUM(points for parameters))
Renal
|
Parameter |
Finding |
Points |
|---|---|---|
|
hypertension (diastolic > 90 mm Hg) |
no |
0 |
|
|
yes |
4 |
|
proteinuria |
no |
0 |
|
|
<= 1 + or <= 0.2 g/24 hrs |
0 |
|
|
> 1+ or > 0.2 g/24 hours |
4 |
|
hematuria |
no |
0 |
|
|
<= 1+ or <= 10 RBC/mL |
0 |
|
|
> 1+ or > 10 RBC/mL |
8 |
|
creatinine |
< 125 µmol/L |
0 |
|
|
125 – 249 µmol/L |
8 |
|
|
250 – 499 µmol/L |
10 |
|
|
>= 500 µmol/L |
12 |
|
rise in creatinine |
none |
0 |
|
|
< 10% |
0 |
|
|
>= 10% |
12 |
subscore for renal =
= MIN(12, SUM(points for parameters))
Nervous System
|
Parameter |
Finding |
Points |
|---|---|---|
|
organic confusion or dementia |
no |
0 |
|
|
yes |
3 |
|
seizures (not hypertensive) |
no |
0 |
|
|
yes |
9 |
|
stroke |
no |
0 |
|
|
yes |
9 |
|
spinal cord lesion |
no |
0 |
|
|
yes |
9 |
|
peripheral neuropathy |
no |
0 |
|
|
yes |
6 |
|
motor mononeuritis multiplex |
no |
0 |
|
|
yes |
9 |
subscore for nervous system =
= MIN(9, SUM(points for parameters))
Birmingham vasculitis activity score =
= SUM(points for the 9 subscores)
Interpretation:
• minimum score: 0
• maximum score: 63
• The higher the score, the greater the activity of the vasculitis.
Specialty: Immunology/Rheumatology
