Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

New Disease Activity Indices in the Management of Behcet's Disease: A Comparative Study of Patients from Turkey and the USA.

Mumcu,  Gonca, Yazici,  Yusuf, Inanc,  Nevsun, Ergun,  Tulin, Filopoulos,  Maria, Direskeneli,  Haner


The aim of this study was to evaluate and compare oral ulcer activity by Composite index (CI) and general disease activity by Behcet Syndrome Activity Score (BSAS) in patients from Turkey (TR) and the USA with Behcet's disease (BD).


In this cross-sectional study, age- matched 30 Caucasian active female patients from TR (mean age: 41.10 ±11.04 years) and 30 Caucasian active female patients from USA (mean age: 41.40± 11.56 years) with BD were included. Patients from TR were examined in Marmara University Hospital, Department of Rheumatology whereas patients from USA were examined in NYU, Hospital for Joint Disease in the same time span. Composite index (CI) was previously validated (1) for oral ulcer activity. It evaluates both pain scored by visual analogue scale (VAS) and functional status. Behcet Syndrome Activity Score (BSAS) (2) is a general disease activity index and evaluates clinical activities according to organ involvement in BD. CI and BSAS were filled by both patients from Turkey (TR) and USA. Scores could be between 0 and 10 in CI and 0 –100 in BSAS, (0=inactive disease). Oral health related quality of life was evaluated by oral health impact profile-14 (OHIP-14) in both groups. Better oral health-related quality of life was indicated with lower scores in OHIP-14 (range 0–56).


No significant difference was found in OHIP-14 scores between patients from TR (21.4±13.7) and USA (21.9±12.7) (p=0.886). Although the number of oral ulcers was higher in patients from TR than patients from USA (4.3±2.5 and 3.3±2.8, respectively), this was not statistically significant (p=0.161). Yet, CI index score and pain score evaluated by VAS as its subscale score, were higher in patients from TR (7.8±1.6, 52.7±22.1) compared to the US patients (4.2±1.5, 35.9±27.8) (p<0.001 and p=0.013, respectively). CI score was correlated with BSAS score in patients from TR (r=0.36 p=0.04) and USA (r=0.44 p=0.02).

BSAS score was higher in patients from USA (44.5±18.5) compared to patients from TR (23.4±15.4)(p<0.0001). In accordance with these results, majority of patients from USA (76.7 %) were treated with immunosuppressive medications compared to patients from TR (6.7 %) (p<0.0001).


CI and BSAS, two patient derived disease activity measures, showed moderate correlation with the manifestations of BD and moderate correlation with one another in these two different patient populations They may be suitable tools for use both in routine clinical care and clinical studies in BD patients.


1MumcuSurInancKaracayliCimilliSismanErgunDireskeneli, GHNUHNTH. A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis. J Oral Pathol Med. 2009;38:785–91.

2ForbessSwearingenYazici, CCY. Behcet's Sydrome Activity Score (BSAS): A New Disease Activity Assessment Tool, Composed Of Patient-derived Measures Only, Is Strongly Correlated With The Behcet's Disease Current Activity Form (BDCAF). Arthritis Rheum 2008; 58: (S9); S854.

To cite this abstract, please use the following information:
Mumcu, Gonca, Yazici, Yusuf, Inanc, Nevsun, Ergun, Tulin, Filopoulos, Maria, Direskeneli, Haner; New Disease Activity Indices in the Management of Behcet's Disease: A Comparative Study of Patients from Turkey and the USA. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1303
DOI: 10.1002/art.29069

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