eugogo clinical activity score

Changes in ocular biomechanics after treatment for active ... Evaluating Graves' Orbitopathy - ScienceDirect Activity is based on four measures of inflammation, pain, redness, swelling, and impaired function, and function is graded with decreasing monocular motion and diminishing visual acuity. Table 3: VISA Inflammatory Index (I) (Dolman and Rootman 2006 [25], ITEDS modified). A prospective study. (PDF) Central Visual Field and Graves Ophthalmopathy ... 9 # The CAS is a composite score with equal weighting of a number of factors . PDF T2-relaxation mapping and fat fraction assessment to ... Choice of treatment should be based on the assessment of clinical activity and severity of GO. CAS < 3 = inactive GO; CAS ≥ 3 = active GO. The 2021 European Group on Graves' orbitopathy (EUGOGO ... The CAS has been shown to be a useful tool in stratifying patients and in avoiding immunosuppressive therapy in those with a low activity score. VEP recording suggested bilateral dysthyroid optic neuropathy, worse in the left. Mild to moderate Graves ophthalmopathy responded very well to conservative management. Bartalena L, Kahaly GJ, Baldeschi L, et al. Orbitopathy (EUGOGO) recommends that the activity and severity of GO be assessed according to standardized criteria to select the most appropriate treatment for individual patients with GO.3 Activity is evaluated using the clinical activity score (CAS).4 Patients with a CAS of ≥ 3 of 7 items are classified as having active GO. clinical activity score (CAS) ≥3/7; or b.) Tense subcutaneous fluid or skin These outcome variables were assessed at baseline, 1st, 3rd, 6th and 12th month after TCZ therapy onset. One point is given for the presence of each of the parameters assessed. The CAS consists of seven findings: spontaneous retrobulbar pain; pain on attempted up or down gaze; redness of the . Gaze evoked orbital pain. The sum of all points defines clinical activity: active ophthalmopathy if the score is above 3/7 at the first examination or above 4/10 in successive examinations. Subcutaneous fluid (black arrows) or skin thickening (white arrows) E&F. Severe CAS 1. The severity of TAO was assessed according to the EUGOGO (3). A score of 3 or more points defined the status as active, and a score of 2 or less than 2—as inactive [2]. Results: Lower QOL scores for the visual functioning subscale were significantly correlated with disease severity, the CAS and diplopia (all p< 0.05). 2. The severity of GO was assessed according to the European Group on Graves' Orbitopathy (EUGOGO). Assessments of clinical activity score (CAS) The assessment of CAS and severity for each eye was determined based on the guidelines of 2016ETA/EUGOGO , which was performed by an experienced endocrinologist on all patients. EUGOGO recommends a CAS of 3 or more out of 7 (the first seven clinical parameters as described in Box 1) as a threshold for active disease. Only score swelling thought to be due to active GO; i.e. The protocol was as follows: 0.5 g . A CAS ≥3/7 is indicative of active GO. Patients were also asked if they had excessive watering, photophobia, grittiness, double vision . Graves' Orbitopathy (GO) is an immune-mediated disorder causing inflammation and expansion of orbital fat and muscle. a)eyelid swellingIf swelling varies between upper and lower eyelid of an eye then use the more severe lid to score that eye. doi: 10.1530/EJE-21-0479. tivity and without TAO activity, the activity being assessed by means of the Clinical Activity Score (CAS) and the severity—according to the EUGOGO classification. A score of 3 or more points defined the status as active, and a score of 2 or less than 2—as inactive [2]. The second ever Ophthalmology Updates conference was held from 29-30 July 2017 at the Westin Hotel, Sydney. ).Onepointisgivenforthepresenceofeach oftheparametersassessed . Mild CAS 0. Exophtalmos <3 mm above normal for race and gender (women 18 mm, men 20 mm) 4. Journal of Ophthalmopathy. Recommended Male to female ratio is 1:2.7 which is highest in the age range of 30-50 years. 2015;2015:249125. Patients' demographic data were collected. 4 JournalofOphthalmology Table 2: Clinical Activity Score (CAS) (amended by EUGOGO after Mouritsetal. dance of smoking. Current GO severity was graded by the EUGOGO classification system, which divides patients into mild, moderate to severe and very severe groups. To describe pre- to post-treatment changes in clinical activity score (CAS) and exophthalmometry in patients with Graves orbitopathy treated with tocilizumab (TCZ). ACTIVITY AND SEVERITY SCORING Activity • CAS (Clinical Activity Score) Severity • VISA (Vision, Inflammation, Strabismus, Appearance) •NOSPECS • EUGOGO (European Group on Graves' Orbitopathy) ACTIVITY SCORING: CLINICAL ACTIVITY SCORE (CAS) •Summed score of periocular inflammatory features •80% positive predictive value to predict . He remained bio-chemically euthyroid and was on no anti thyroid medication. The resulting spectrum of ocular and orbital changes may cause significant visual and cosmetic morbidity and are graded as disease severity. Clinical activity score in Graves' Ophthalmopathy Scoring guide EYELID SWELLING EYELID ERYTHEMA CONJUNCTIVAL REDNESS CARUNCLE AND PLICAL INFLAMATION A&B. All the patients are to receive intravenous GCs pulse therapy. The sum of all points defines clinical activity: active ophthalmopathy if the score is above 3/7 at the first examination or above 4/10 in successive examinations. Risk factors include smoking, thyr … Disease activity was diagnosed based on the Clinical Activity Score (CAS). Clinical Activity Score (CAS) (amended by EUGOGO after Mourits et al.). Clinical manifestation, the activity, severity and management of the disease were assessed using EUGOGO scale and Clinical Activity Score (CAS). Severity is rated as mild, moderate to severe and sight threatening (or very severe). The values with p < 0.05 were considered statistically significant, and all p values were based on two-tailed tests. GO was diagnosed on the basis of the recommendation by the European Group on Graves' Orbitopathy (EUGOGO), and disease activity was assessed by the clinical activity score (CAS). Patients between 18 years and 60 years of age who are diagnosed as moderate-to-severe and active GO (Clinical Activity Score (CAS) ≥3) according to the EUGOGO 2021 Guideline8 and have not been treated are eligible to participate. CT orbits re-vealed marked enlargement of extra-ocular muscles in both eyes with apical crowding. The main outcomes were the best-corrected visual acuity (BVCA), Clinical Activity Score (CAS) and intraocular pressure (IOP). Orbitopathy (EUGOGO), we report the results of a multicenter, randomized, double-blind, placebo- . Clinical Activity Score (CAS), European Group on Graves' Orbitopathy (EUGOGO), NOSPEC classification guidelines or VISA (vision, inflam-mation, strabismus and appearance) scoring guidelines. Criteria for activity and severity assessment are reported in table table2 2 and have not been changed since 2008 [1,2]. This study compares the results after PIM for both criteria and evaluates the number of rehabilitative surgeries performed in relation to treatment outcome. The signal intensities of extraocular muscles were scanned using short-tau inversion recovery (STIR) sequences from MRI. For each of the items present, one point is given. Spontaneous orbital pain. W. Jean Philippe. 1. The Mann-Whitney test was used for differences between the two groups. Soft tissue inflammation and activity was graded by clinical activity scores based on inflammatory signs of the orbit (pain, redness and swelling). If TED is suspected, one must determine disease activity and severity in order to assess the urgency of treatment. 1 assessment clinical activity and severity of graves' orbitopathy (go) should be assessed according to standardized criteria and go be categorized as active or inactive, and mild, moderate-to-severe, or sight-threatening, and should include evaluation of quality of life (qol) by the eugogo disease-specific go-qol questionnaire 1, øøøo 2 … Each of the 12 speakers presented one 'common' topic and one 'cutting edge' topic from their subspecialty, followed by case presentations as illustrations. To assess activity, the most commonly used system is the Clinical Activity Score (CAS) . Results: Clinical success was achieved in 54 (61.4%), 57 (64.8%), and 61 (69.3%) patients at 3-, 6-, Central Visual Field and Graves Ophthalmopathy. The effect of clinical activity scores (CAS), NO SPECS scores, and EUGOGO scores on Graves' ophthalmopathy quality of life (GO-QoL) scores of functional visual and appearance domains. One point is given for the presence of each of the parameters assessed. Graves' Orbitopathy (GO) is an immune-mediated disorder causing inflammation and expansion of orbital fat and muscle. Clinical Activity Score (CAS) (amended by EUGOGO after Mourits et al.). Plan A - Proportion of patients achieving response in reduction of clinical activity score (CAS) [ Time Frame: 16 weeks ] Reduction of CAS at Week 16 defined as reduction of ≥ 2 points from Baseline in the study eye without deterioration (≥ 2 point increase) of CAS in the fellow eye. Based on its clinical signs and symptoms, GO is graded as mild, moderate-to-severe, or severe, and active or inactive, the latter feature being established on a 5/7-scale score named Clinical Activity Score (CAS). A clinical activity score (CAS) 1,11,12 was obtained by assessing two symptoms (orbital ache and gaze‐evoked pain) and five signs (conjunctival redness, eyelid erythema, eyelid oedema, chemosis and swelling of the plica or caruncle) for each eye. UnitedHealthcare Oxford Clinical Policy Effective 05/01/2021 ©1996-2021, Oxford Health Plans, LLC gaze evoked orbital pain, swelling, eyelid erythema, redness, chemosis, inflammation, clinical activity score and assessments of functional vision and patient appearance. Gaze evoked orbital pain. Table 2: Clinical Activity Score (CAS) (amended by EUGOGO after Mourits et al.). Clinical Activity Score >3 31/51 (61%) 6/17 (86%) 7/17 (41%) 85 . The significance of association between choroidal thickness and clinical activity score according to the EUGOGO guidelines was determined by Pearson's correlation coefficient test. Barrio-Barrio J, et al. EUGOGO aims to standardise clinical assessment10 in order to perform multi-centre trials. One point is given for the presence of each of the parameters assessed. This survey aimed to identify . 2. At the initial visit, patients are given a CAS score of 1-7, one point for each sign or symptom (Figure 19): The disease follows a biphasic course with an . The disease severity of GO was measured by the European Group on Graves' Orbitopathy (EUGOGO) classification, and clinical activity was evaluated by the clinical activity score (CAS). Result: A total of 97 GO patients included in the study. Eyelid swelling that is considered to be due to active (inflammatory phase) GO. Evaluating Graves' Orbitopathy. The 2021 European Group on Graves' Orbitopathy (EUGOGO) Clinical Practice Guidelines for the Medical Management of Graves' Orbitopathy [published online ahead of print]. The disease activity was determined using the Clinical Activity Score (Mourits, 1989), based on the presence of the classic symptoms of inflammation: pain (2 points), hyperemia (2 points), edema (4 points), dysfunction (2 points). Examination revealed good visual acuity of 6/6, full colour vision, 20 mm proptosis on exophthalmometer and 1/7 clinical activity score (CAS) bilaterally. The sum of all points defines clinical activity: active ophthalmopathy if the score is above 3/7 at the first examination or above 4/10 in successive examinations. - "Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management" in each eye, as measured by orbital CT. Activity of TAO was assessed via the clinical activity score (CAS) (7). Best corrected visual acuity was 6/9 (Snellen) or worse in 75% of DON eyes. If active GO is identified, anti-inflammatory and immunomodulatory therapy are discussed and the risks and benefits of such therapies are outlined." Activity is easily measured by the clinical activity score (CAS) . Disease activity is assessed through theratingoftheitemsofthemodi edCAS(Table) .is ClinicalActivityScoreisbasedonfourofthe vewell-known classical signs of inammation (pain, redness, (warmth), swelling, and impaired function). The resulting spectrum of ocular and orbital changes may cause significant visual and cosmetic morbidity and are graded as disease severity. A total of 20 consecutive GO patients and 20 age- and sex-matched healthy control subjects were included. - "Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and . Diagnosis of TAO was based on the EUGOGO consensus . Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. Patients with high scores (above 5 of 10) or with evidence of progression in the inflammation are offered a more aggressive therapy. The Clinical Activity Score (CAS) (Mourits et al., 1989, 1997) is used widely to assess disease activity, with 7/10 points relating to cardinal features of inflammation and 3/10 to change in severity over time. "We classify GO activity using the clinical activity score and the severity based on EUGOGO guidelines with the categories of mild, moderate to severe, and sight threatening. Clinical Activity Score (CAS) (amended by EUGOGO after Mourits et al) For initial CAS, only score items 1-7 1. Results: TAO activity was detected in 45 patients (90 eyes, 53%) with MTS of 23.54 ± 5.73 mm, IOP of 19.78 ± 4.49 mm Hg, Hertel ex- Mild soft-tissue involvement 3. The disease activity was determined using the Clinical Activity Score (Mourits, 1989), based on the presence of the classic symptoms of inflammation: pain (2 points), hyperemia (2 points), edema (4 points), dysfunction (2 points). 3 This document advises the use of the "clinical activity score" and . EUGOGOActivityMeasuresofGraves Ophthalmopathy: Clinical Activity Score. Mild to moderate Graves ophthalmopathy responded very well to conservative management. Further Reading: Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. activity clinically; a widely used tool is the clinical activity score (CAS) [3], but it has been criticised as too binary, subjective and lacking in sensitivity [4]. Clinical severity was judged by scores of the modified NOSPECS classification, and inflammatory activity was measured by a seven-point scale of clinical activity score (CAS). Patients with moderate inflammatory index (less than 4 of 10) are managed conservatively. He had developed only mild thyroid eye disease at this stage with some lid retraction and conjunctival hyperemia. Clinical activity scores as well as orthoptic assessments were consistently evaluated. Clinical Activity Score. A number of protocols and tools are available to aid a TED diagnosis. Clinical Activity Score •Score > 4 -Positive predictive value 80% -Negative predictive value 64% Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clin Endocrinol (Oxf). The EUGOGO criteria and the clinical activity score (CAS) have been used as outcome measures to report response rates for patients after pulsed intravenous methylprednisolone (PIM) therapy. Clinical severity was judged by scores of the modified NOSPECS classification, and inflammatory activity was measured by a seven-point scale of clinical activity score (CAS). In comparison, the NO SPECS and EUGOGO classification assess the clinical severity. Median Clinical Activity Score was 4/7 but 25% scored 3 or less, indicating severe inflammation was not essential. The dose was increased to 15 mg after 16 months of euthyroidism. Assessment the degree of GO severity based on EuGOGO Mild GO Mild GO manifestations have a minimum impact on the daily life. Clinical Activity Score (CAS) (amended by EUGOGO after Mourits et al.). Assessment of activity by the clinical activity score (CAS)*. 2008 Mar;158(3):273-85. EUGOGO classification was used to classify severity of the disease in mild, moderate, severe, and very severe; whereas, clinical activity score (CAS) was implied to categorise the disease activity. The EUGOGO classification divides GO according to the impact of the disease on the patient's quality of life and the risk of vision loss if it has minimum impact on the patient's life in mild cases or if the disease has a significant impact on the patient's . EUGOGO classification was used to classify severity of the disease in mild, moderate, severe, and very severe; whereas, clinical activity score (CAS) was implied to categorise the disease activity. Material &Methods: This retrospective study included 51 TED patients (84 orbits) who underwent endoscopic orbital decompression (EOD) or balanced orbital decompression.The effect of surgical treatment was evaluated via the clinical activity score (CAS), modified NOSPECS and EUGOGO classification. Early referral to specialized centers is fundamental for most patients with GO. It usually appears in one or more of the following signs : Score 1. Material and methods Eight Mexican patients presenting with active Graves orbitopathy (CAS > 3/7) previously treated with glucocorticoids received 1 monthly dose of TCZ for 6 months. : (a) Activity measures based on the classical features of inflammation: clinical activity score (CAS) is the sum of all items present (43, 44) Eur J Endocrinol. Graves' orbitopathy (GO) is the most common extra-thyroidal manifestation of Graves' disease (GD). One point is given for the presence of each of the parameters assessed. therapy (20 Gy). 2021 Jul 1:EJE-21-0479.R1. GO activity was assessed by the Clinical Activity Score (CAS) developed by the European Group on Graves' Orbitopathy (EUGOGO). C&D. Moderate CAS 1. Colour vision was reduced in 33 eyes, of which all but one had DON. With binary scoring of inflammatory features, however, progression or regression cannot be scored, only onset and resolution. The primary clinical outcome was the overall response rate. The CAS was also based on the EUGOGO consensus . "We classify GO activity using the clinical activity score and the severity based on EUGOGO guidelines with the categories of mild, moderate to severe, and sight threatening. Disease Activity In assessing the activity level of TED in a patient, the clinical activity score (CAS) can be used [15]. The sum of all points defines clinical activity: active ophthalmopathy if the score is above 3/7 at the first examination or above 4/10 in successive examinations. EUGOGO: European Group on Graves' Orbitopathy VISA: Vision, Inflammation, Strabismus, Appearance NOTES: The VISA and CAS were designed to determine the clinical activity. 3. The Society. References. The visit at 3 months was scheduled to check Results The mean GO-QOL scores were 73.7 (standard deviation (SD), 26) for visual functioning, 61.9 (SD 26) for appearance, and 67.8 for total quality of life (QOL; SD 22). CAS: clinical activity score. Minor lid retraction (<2 mm) 2. Active TAO was defined by a.) Clinical Activity Score (CAS) (amended by EUGOGO , after Mourits et al) For initial CAS, only score items 1-7 1. His clinical activity score was 6/10 at this stage. Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease (GD). The mean GO-QOL scores. 1997 Jul;47(1):9-14. That data, reported separately, focused on Clinical Activity Score (CAS) and indicated in one trial a strong benefit of RTX in comparison with IV glucocorticoids, whereas the other trial noted the absence of a benefit by comparison with placebo. 10-13 While the ophthalmic manifestation of the moderate to severe disease may be readily picked up by general physicians and ophthal - The disease follows a biphasic course with an . 'Response' was defined as an EUGOGO is a multidisciplinary Scientific Society of ophthalmologists, endocrinologists, basic scientists and (neuro-)radiologists who have a special clinical and research interest in GO with the overriding goal of improving patient care. Each positive criterion on the CAS is given one point and a score of 3 or greater . A ten-item CAS, including an increase in exophthalmos of ≥2 mm, a decrease in eye motility of ≥8° or a decrease in visual acuity in the last 1-3 months, is useful to assess progression of GO after the first visit. appearance should have changed with disease, and fat prolapse is not scored as 'swelling'. If active GO is identified, anti-inflammatory and immunomodulatory therapy are discussed and the risks and benefits of such therapies are outlined." Clinical activity scores, improved levels of diplopia, and single muscle excursions were considered major criteria for treatment success. Each team comprises an ophthalmologist and an endocrinologist running a joint clinic for patients with GO. Clinical outcome assessment. A cri tical analysis o f classi. A lower score indicates fewer symptoms. At the initial visit CAS is reported on a scale of 1 to 7 and assigns points for the following: spontaneous orbital pain, gaze-evoked orbital pain, eyelid swelling due to active TED, eyelid erythema, conjunctival redness due to active TED, chemosis, or . (EUGOGO) classi ca tions are the two widely used grading systems conceived to assess the ac tivi ty and s everity of GO and guide the therapeu t ic decisio n making. item Clinical Activity Score at 6 months. Spontaneous orbital pain. Evaluating Graves' Orbitopathy. Perhaps the best known is the Clinical Activity Score (CAS), a 7-point scale using classic signs and symptoms of inflammation to detect Active TED during physical exams. Material and methods: Changes of Clinical Activity Score (CAS) for GO, proptosis, levels of thyroid-stimulating hormone receptor antibodies, and depletion of CD19+ and CD20+ B-lymphocytes were determined in ten patients (two men and eight women) with active moderate-to-severe GO treated with a single 100-mg dose of rituximab. Signal intensities of extraocular muscles were scanned using short-tau inversion recovery ( )! Offered a more aggressive therapy euthyroid and was on NO anti thyroid medication..! No SPECS and EUGOGO classification assess the clinical severity managed conservatively gender ( women mm! Muscles were scanned using short-tau inversion recovery ( STIR ) sequences from MRI or with of... Score & gt ; 3 = inactive GO ; CAS ≥ 3 = active GO ;.... All the patients are to receive intravenous GCs pulse therapy of choroidal thickness and vascular. 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