Behçet's disease ocular attack score 24: evaluation of ocular disease activity before and after initiation of infliximab.
OBJECTIVE
We developed a novel scoring system for uveitis due to Behçet's disease (BD), termed Behçet's disease ocular attack score 24 (BOS24), and examined its validity and usefulness by estimating changes in ocular disease activities both before and after initiation of infliximab therapy.


METHODS
BOS24 consists of a total 24 points divided into 6 parameters of ocular inflammatory symptoms. To examine the validity of our scoring system, 5 uveitis specialists examined the severity of 50 ocular attacks in clinical charts using both our system and a physician's impression score (grade 1-10). In addition, ocular disease activities both before and after initiation of infliximab were retrospectively examined in 150 cases of ocular BD using BOS24.


RESULTS
The average BOS24 for the 5 doctors was highly correlated with the average physician's impression score (p < 0.0001), whereas the coefficient of variance for BOS24 among doctors was much lower than that for the physician's impression score (p < 0.0001). Summation of BOS24 over a 6-month period (BOS24-6M) was significantly reduced after starting infliximab therapy (p < 0.0001). The average BOS24 for individual ocular attacks was also significantly decreased after starting infliximab, with scores for the posterior pole and fovea notably improved.


CONCLUSIONS
BOS24 was highly related to severity noted by the physician's impression and had a low level of variability among the examined doctors. Using our novel scoring system, infliximab therapy was shown to reduce not only the frequency of ocular attacks, but also the severity of each attack. BOS24 is a promising tool for evaluating ocular BD activities.
Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, kabutosi-tky@umin.ac.jp.
Toshikatsu
T
Kaburaki
Kenichi
K
Namba
Koh-hei
KH
Sonoda
Takeshi
T
Kezuka
Hiroshi
H
Keino
Takako
T
Fukuhara
Koju
K
Kamoi
Kei
K
Nakai
Nobuhisa
N
Mizuki
Nobuyuki
N
Ohguro
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001528:Behcet Syndrome / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D014605:Uveitis / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D000069285:Infliximab