Who best assesses Crohn’s disease?

Abstract

Knowledge of the presence and the degree of inflammation in Crohn’s disease would be useful in multicentre therapeutic trials. Objectives; The purpose of the present study was two fold, (a) to determine the relationship between clinical assessment of activity by two clinicians with four previously published indices, the Crohn’s disease activity index (CDAI), the Van Hees activity index (AI), the simple index of Harvey and Bradsaw (SI) and the Fielding index and (b) for the first time, to study the internal correlation between these four indices. Methods: A hundred and ninety-four assessments were performed on 56 patients with Crohn’s disease. Following each clinical assessment, the aforementioned indices were calculated. Results: Both clinicians gave the same rating of activity in 81% (157) of assessments. A good relationship was observed between the median indicial values and the clinical gradings for all four indices. The best relationship was demonstrated with the AI with no overlap in 50% values with increasing grades of disease activity. All four indices demonstrated a good correlation with each other (p<0.01). The best correlation was observed between more objective indices the AI and the Fielding index (r=0.79) for first assessments only. Conclusion: The Van Hees AI is a reliable measure of inflammatory activity in Crohn’s disease and would be useful in multicentre therapeutic trials.