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Measurement of damage in systemic vasculitis: a comparison of the Vasculitis Damage Index with the Combined Damage Assessment Index
  1. Ravi Suppiah1,
  2. Oliver Flossman2,
  3. Chetan Mukhtyar3,
  4. Federico Alberici4,
  5. Bo Baslund5,
  6. Denise Brown1,
  7. Nadeem Hasan1,
  8. Julia Holle6,
  9. Zdenka Hruskova7,
  10. David Jayne2,
  11. Andrew Judge8,
  12. Mark A Little9,
  13. Peter A Merkel10,
  14. Alessandra Palmisano4,
  15. Philip Seo11,
  16. Coen Stegeman12,
  17. Vladimir Tesar7,
  18. Augusto Vaglio4,
  19. Kerstin Westman13,
  20. Raashid Luqmani1,8
  1. 1Department of Rheumatology, Nuffield Orthopaedic Centre, Oxford, UK
  2. 2Department of Nephrology, Addenbrooke's Hospital, Cambridge, UK
  3. 3Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
  4. 4Department of Nephrology, University of Parma, Parma, Italy
  5. 5University Hospital of Copenhagen, Copenhagen, Denmark
  6. 6Vasculitis Centre/Department of Rheumatology, University Hospital of Schleswig–Holstein, Luebeck, Germany
  7. 7First Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
  8. 8NIHR Musculoskeletal BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  9. 9Centre for Nephrology, UCL Royal Free Campus, London, UK
  10. 10Boston University Vasculitis Center, Boston, Massachusetts, USA
  11. 11The John Hopkins Vasculitis Center, Baltimore, Maryland, USA
  12. 12University Medical Center Groningen, Groningen, The Netherlands
  13. 13University Hospital MAS, Malmö, Sweden
  1. Correspondence to Dr Ravi Suppiah, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK; ravi.suppiah{at}


Objectives To compare the Vasculitis Damage Index (VDI) with the Combined Damage Assessment Index (CDA) as measures of damage from vasculitis.

Methods A total of 283 patients with vasculitis from 11 European centres were evaluated in a cross-sectional study using the VDI and CDA.

Results Wegener's granulomatosis (58.4%) and microscopic polyangiitis (11.0%) were the most common diagnoses. Agreement between VDI and CDA scores (Spearman's correlation) was 0.90 (95% CI 0.87 to 0.92). There was good correlation between individual comparably evaluated organ systems (Spearman's correlation 0.70–0.94). Interobserver reliability (assessed by intraclass correlation coefficient (ICC)) was 0.94 (95% CI 0.89 to 0.98) for VDI and 0.78 (95% CI 0.63 to 0.93) for CDA. Intraobserver reliability was 0.92 (95% CI 0.83 to 1.00) for VDI and 0.87 (95% CI 0.75 to 1.00) for CDA. A total of 13 items were not used in the VDI compared to 23 in the CDA. Observers agreed that the CDA covered the full spectrum of damage attributable to vasculitis but was more time consuming and thus possibly less feasible for clinical and research purposes.

Conclusions The VDI and CDA capture reliable data on damage among patients with vasculitis. The CDA captures more detail but is more complex and less practical than the VDI. Further evolution of damage assessment in vasculitis is likely to include key elements from both instruments.

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  • Funding This study was substantially funded by a project grant from the European League Against Rheumatism (EULAR) with additional support from the US National Institutes of Health (grants U54 RR019497, U54AR057319 and U01 AR1874).

  • Competing interests None.

  • Ethics approval Local ethics requirements were met by each of the 11 sites.

  • Provenance and peer review Not commissioned; externally peer reviewed.