The Vasculitis Damage Index (VDI) is the most widely used and validated method to document vasculitis damage irrespective of disease activity.
The measurement of vasculitis damage relates to chronic changes or scarring that has occurred since the onset of vasculitis, either as a result of the disease itself, the side effects of treatment, or any
other comorbidity occurring after the diagnosis of vasculitis has been made.
Recognising the presence of damage is crucial because it represents problems that may require specific intervention unrelated to immunosuppression, and, in the long term, limiting the amount of damage experienced by a patient is likely to result in an improved overall outcome.
Whilst the VDI can be used to record accumulating damage as a result of vasculitis; it’s treatment or anything else occurring after vasculitis onset, a complementary tool called the Birmingham Vasculitis Activity Score (BVAS) is used to record current disease activity.
The VDI consists of a list of findings grouped into 11 systems: musculoskeletal; skin/mucous membranes; ocular; ENT; pulmonary; cardiovascular; peripheral vascular disease; gastrointestinal; renal; neuropsychiatric and an additional section for additional damage items.
The “other” section includes gonadal failure, marrow failure, diabetes, chemical cystitis, malignancy, as well as the opportunity to document any other unlisted feature that can be considered as damage.
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Using a nominal group consensus approach, the Birmingham Vasculitis Group generated guiding principles for assessment of damage in all systemic vasculitides. Damage was defined as irreversible change resulting from scars. Consensus principles were developed into the VDI, including guidelines for use, a list of items of damage, and a glossary.
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The Vasculitis Damage Index deals with features that have occurred since the onset of vasculitis, regardless of whether or not they are attributable to vasculitis. It is very simple to calculate; each item contributes one point to the total score.
However it is important to remember that it is cumulative, so that each time VDI is evaluated, you should include all the items from the previous assessment as well as adding any additional ones (i.e. it never gets better).
This is where VDI differs from BVAS.
For the VDI, damage is defined as having been present or currently present for at least 3 months, even if this has completely disappeared after this time.
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The Luqmani Group have developed comprehensive case-study based training modules for the BVAS and VDI and facilitate the training online or in-person to ensure valid use in studies. They have developed a training website to deliver the case studies with automated feedback and have collaborated with academics and industrial partners to ensure quality control in disease evaluation.
For more information, please contact David Gray and Raashid Luqmani via bvasvdi@ndorms.ox.ac.uk.
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