title: A quantitative assessment of alkaptonuria: testing the reliability of two disease severity scoring systems.
abstract: Alkaptonuria (AKU) is due to excessive homogentisic acid accumulation in body fluids due to lack of enzyme homogentisate dioxygenase leading in turn to varied clinical manifestations mainly by a process of conversion of HGA to a polymeric melanin-like pigment known as ochronosis. A potential treatment, a drug called nitisinone, to decrease formation of HGA is available. However, successful demonstration of its efficacy in modifying the natural history of AKU requires an effective quantitative assessment tool. We have described two potential tools that could be used to quantitate disease burden in AKU. One tool describes scoring the clinical features that includes clinical assessments, investigations and questionnaires in 15 patients with AKU. The second tool describes a scoring system that only includes items obtained from questionnaires used in 44 people with AKU. Statistical analyses were carried out on the two patient datasets to assess the AKU tools; these included the calculation of Chronbach's alpha, multidimensional scaling and simple linear regression analysis. The conclusion was that there was good evidence that the tools could be adopted as AKU assessment tools, but perhaps with further refinement before being used in the practical setting of a clinical trial.
authors: Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool, L69 3GL, UK. coxt@liv.ac.uk
authors: Trevor F
authors: TF
authors: Cox
authors: Lakshminarayan
authors: L
authors: Ranganath
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000474:Alkaptonuria / Q000175:diagnosis* / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003512:Cyclohexanones / Q000627:therapeutic use; D005260:Female; D050560:Homogentisate 1,2-Dioxygenase / Q000172:deficiency; D006713:Homogentisic Acid / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009579:Nitrobenzoates / Q000627:therapeutic use; D009794:Ochronosis / Q000175:diagnosis* / Q000188:drug therapy / Q000201:enzymology / Q000453:epidemiology*; D010146:Pain / Q000453:epidemiology; D012044:Regression Analysis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D003512:Cyclohexanones; D009579:Nitrobenzoates; D050560:Homogentisate 1,2-Dioxygenase; C077073:nitisinone; D006713:Homogentisic Acid