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