Siegel et all developed an index to define the overall disease severity in Crohn's disease. This can help to monitor the patient over time and any response to therapy. The authors are from multiple institutions from the United States, Canada, Europe, New Zealand and Hong Kong.
Patient selection: Crohn's disease
Outcome: overall disease activity
Parameters:
(1) mucosal lesions (confirmed by MRI or endoscopy)
(2) fistula at the time of the office visit
(3) perianal abscess at the time of the office visit
(4) intestinal resections
(5) stoma at the time of the office visit
(6) disease extent
(7) frequency of loose stools per week
(8) stricture at the time of the office visit
(9) CRP level in mg/L
(10) use of biologics
(11) impact on daily activities
(12) serum albumin level in g/dL
(13) anorectal symptoms (anorectal pain, bowel urgency, incontinence, discharge, tenesmus)
(14) anemia (by WHO criteria for age and gender)
(15) abdominal pain
(16) steroid use in past year
|
Parameter |
Finding |
Points |
|
mucosal lesions |
none |
0 |
|
|
small |
6 |
|
|
large and/or deep |
16 |
|
fistula |
absent |
0 |
|
|
present |
11 |
|
perianal abscess |
absemt |
0 |
|
|
present |
10 |
|
intestinal resections |
none |
0 |
|
|
at least 1 < 40 cm |
2 |
|
|
at least 1 >= 40 cm |
7 |
|
stoma |
absent |
0 |
|
|
present |
7 |
|
disease extent |
limited |
0 |
|
|
extensive (pancolitis or ileal involvement >= 40 cm) |
6 |
|
frequency of loose stools |
less than per week |
0 |
|
|
>= 10 per week |
6 |
|
stricture |
absent |
0 |
|
|
present |
5 |
|
CRP level |
normal (<= 3 mg/L) |
0 |
|
|
3.01 to 5 mg/L |
2 |
|
|
> 5 mg/L |
5 |
|
use of biologics |
never used |
0 |
|
|
some improvement with |
2 |
|
|
no improvement with |
5 |
|
daily activity impact |
none |
0 |
|
|
significantly impacts |
5 |
|
serum albumin |
>= 3.5 g/dL |
0 |
|
|
< 3.5 g/dL |
4 |
|
anorectal symptoms |
no symptoms |
0 |
|
|
any symptoms |
4 |
|
anemia |
absent |
0 |
|
|
present |
4 |
|
abdominal pain |
infrequent (not daily) |
0 |
|
|
daily |
3 |
|
steroid use |
none |
0 |
|
|
any |
2 |
total score =
= SUM(points for all 16 parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• The higher the score the more active the Crohn's disease.
Specialty: Gastroenterology
