Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy: a novel approach.
Open accessAbstract
Patients with serious inflammatory Graves' ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 'activity score' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment.
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The clinical activity score (CAS) ranges from 0 to 10 and predicts response to anti-inflammatory therapies.
“The score ranges from 0 to 10 and predicts response to anti-inflammatory therapies (523,524).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [523]
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Research works printed but not linked: 1
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“A recent trial from Japan (540) randomized patients without GO or inactive GO (i.e., CAS 3 or T2-weighted imaging T2SIR £1) to receive either glucocorticoid prophylaxis with low-dose prednisolone (on average 0.28 mg/kg per day tapered rapidly over 6 weeks) or no prophylaxis at all.”
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- Authors
- Mourits, M. P., Koornneef, L., Wiersinga, W. M., Prummel, M. F., Berghout, A., & van der Gaag, R.
- Affiliations
- University of Amsterdam (NL)
- Venue
- British Journal of Ophthalmology
- Publisher
- BMJ
- Published
- 1989-08-01
- Volume
- 73
- Issue
- 8
- Pages
- 639-644
- ISSN
- 0007-1161 (ISSN-L)
- PMC
- PMC1041835
- OpenAlex
- W2089992103
- Cited by
- 721
- References
- 15
- Citations by year
- 2026: 45 · 2025: 40 · 2024: 52 · 2023: 47 · 2022: 27 · 2021: 34 · 2020: 30 · 2019: 26 · 2018: 30 · 2017: 12 · 2016: 23 · 2015: 20 · 2014: 28 · 2013: 21 · 2012: 22
- FWCI
- 6.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Ophthalmology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Ocular Disorders and Treatments
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Keywords
- Graves' ophthalmopathy, disease activity assessment, clinical classification, activity score, radiotherapy, extraocular muscle enlargement, treatment response prediction
- MeSH terms
- Adult, Aged, Female, Graves Disease, Humans, Male, Middle Aged, Pilot Projects, Severity of Illness Index
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