Background/Purpose: Uveitis is commonly defined as inflammation of the uvea, the vascular middle layer of the eye. Standardized and validated outcome measures are lacking in uveitis management, which makes it difficult to compare the efficacy and responses to treatment.

To develop a disease activity score for patients with uveitis and determine its discriminating ability to classify patients based on the level of activity. 

Methods: Multicenter cross-sectional observational study. The construct “uveal inflammation activity” was defined as intraocular inflammation. 7 dimensions and 14 items were identified and were agreed among experts through a two-round Delphi technique. The dimensions were: visual acuity, anterior chamber, vitreous cavity and posterior segment inflammation, uveitic macular edema, patient and physician global assessment. 8 Spanish hospitals with uveitis units participated in the study. Patients diagnosed with uveitis, older than 5 years and inflammatory activity at the time of the visit, were selected. Primary endpoint: uveitis inflammatory activity, defined as any intraocular inflammation and categorized as mild, moderate and severe. An ordinal logistic regression model was built whose dependent variable was the inflammatory activity (mild, moderate, severe). The modelling accuracy to classify the patient in the right category was assessed with the Area Under the Curve (AUC). Two AUC measures were calculated: one for the discrimination of mild versus moderate and severe activity level of uveitis and another for the discrimination of mild and moderate versus severe activity. 

Results: 195 patients were included, 54% were women and the mean age was 45.8±16.1 years. The results of the regression model revealed that the uveitis was more severe in patients with an elevated number of anterior chamber cells (OR_{4 cells vs 0cells}=27.85;95%CI=3.42;226.75), high degree of vitreous haze (OR_{severe vs null}=3.95;95%CI=1.40;11.16), macular edema over 315 micras (OR>_{315 vs ≤315}=3.58;95%CI=1.56;8.21), presence of vessel sheathing (OR_{yes vs no}=4.43;95%CI=1.71;11.53), higher patient’s evaluation (OR_{1-unit increase}=1.23;95%CI=1.09;1.39), presence of papilitis (OR_{yes vs no}=4.05;95%CI=1.18;13.92) and elevated number of choridal or retinal lesions (OR_{≥6 vs 0}=4.99;95%CI=1.08;23.01). The discriminant capacity of disease activity index is 87% (95%CI:82%-92%) for discriminating patients with mild uveitis from patients with moderate or severe uveitis and 88%(95%CI:84%-95%) for discriminating patients with mild or moderate uveitis from patients with severe uveitis.

Conclusion: This composite disease activity index in uveitis integrates all ocular inflammatory activity and takes into account the assessment of the patient and the doctor. The index has a high capacity to classify the inflammatory activity of the patients with uveitis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-an-activity-disease-score-in-patients-with-uveitis/