A COMPOSITE INDEX FOR DETERMINING THE IMPACT OF ORAL ULCER ACTIVITY IN BEHCET'S DISEASE AND RECURRENT APHTHOUS STOMATITIS

Background: Oral ulcer is a cardinal clinical symptom in Behcet's disease (BD) and affects oral functions negatively. However, no standardized activity index is currently present to monitor clinical manifestations affected by oral ulcers. Objectives: The aim of this study was to develop a composite index for oral ulcer activity in patients with BD. Methods: In this cross-sectional study, 121 patients with BD (F/M: 59/62, mean age: 37.4±11.9 years) and 36 patients with recurrent aphthous stomatitis (RAS, 24/12, 35.7±12.1 years) were included. BD patients were treated with colchicine (1,5 mg/day, n=80) or immunosuppressives (n=34). Seven BD patients and RAS patients (100%) did not use medications regularly. The number of oral ulcers was noted on a standard chart by the patient. Seventy-nine BD patients (65,3%) and RAS patients (100%) were active during the previous 3 months. Twenty dental patients with infections and pain were selected as a control group. A composite index (CI) regarding presence of oral ulcer, oral ulcer related pain status evaluated by visual analogue scale (0-100 mm) and functional disability coded by Likert type scale was developed to monitor the activity. CI score could be 0 to 10. The score was evaluated in patients with active and inactive patients for content validity. Correlations between the number of oral ulcers and CI score were evaluated for convergent validity. CI scores were compared between in patients with oral ulcers and dental patients for discriminant validity. In addition, 31% of patients (n=37) were re-examined for test-retest analysis after 3 hours at the same day. In addition, 53% of patients were examined by both observer 1(GM) and observer 2(NI) to evaluate interobserver difference variability. Results: CI score was higher in active patients with oral ulcers (6.01±2.04) than inactives (0±0) in BD (0.000). CI score was observed to be higher in patients with RAS (7,04±1,9) compared to active patients with BD (p=0.018). Although the number of oral ulcers were similar in BD (3.5±3.4) and RAS (3.9±2.6)(p=0.83), healing time of oral ulcers was significantly higher in RAS (10.2±3.9) compared to BD (7.3±4.04)(p=0.001). CI score correlated with the number of oral ulcers in BD (r=0.49, p=0.000) and RAS (r=0.5, p=0.000). Healing time of oral ulcers was also correlated with CI score in RAS (r=0.4 p=0.019). Patients with dental infections had no score in CI. No significant differences was observed in CI score according to test-retest results and interobserver results (p>0.05). Conclusion: The presented composite index seems to be a reliable and suitable tool for evaluating the clinical impact of oral ulcer activity in BD and RAS. As oral ulcer activity pattern was found to be different in BD compared to RAS with CI, disease-specific problems could also be assessed better. Disclosure of Interest: NoCitation: Annals of the Rheumatic Diseases, volume 68, supplement 3, year 2009, page 82Session: Abstract Session: Vasculitis (Oral Presentations )