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CDAI - Crohn's Disease Activity Index

CDAI - Crohn's Disease Activity Index

The Crohn's Disease Activity Index, or CDAI, used to determine how Crohn's Disease affects a patient's quality of life and the effect of treatment. The CDAI uses a questionaire with responses scored numerically and weighted. Scores are then ranked according to severity of the disease. Remission is often defined as a CDAI score < 150. [1][2][3][5]

There are multiple different questions that aim to quantify CDAI. The value the CDAI questionaire is a matter for debate. One concern of the CDAI and its ability to quantify a patient's quality of life lies in the limited number of questions on pain. Pain intensity known to be a major factor in many diseases and conditions, including IBD.[4]

Here is the link to a website with an online CDAI Calculator.[6]

In an attempt to quantify how a disease affects the overall quality of life the "Health Related Quality of Life (HRQL) scoring system was developed. Like the CDAI, the HRQL can be used to assess quality of life effects of treatment but can also measure effects of treatment and how they relate to changes in the quality of life due treatment side effects.[7]

References

1. Best WR, Becktel JM, Singleton JW and Kern F Jr. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology. 1976 Mar;70(3):439-44.

2. van Hess PAM, van Elteren PH, van Lier HJJ et al. An index of inflammatory activity in patients with Crohn's disease. Gut 1980;21:279-286.http://gut.bmj.com/content/21/4/279.long

3. Yoshida EM. The Crohn's disease activity index, its derivatives and the inflammatory bowel disease questionnaire: A review of instruments to assess Crohn's disease. Can J Gastroenterol;13(1)65-73.
http://www.pulsus.com/journals/pdf_f...type=Physician

4. Schirbel A, Reichert A, Roll S, et al. Impact of pain on health-related quality of life in patients with inflammatory bowel disease. World J Gastroenterol. 2010 Jul 7;16(25):3168-77. http://www.wjgnet.com/1007-9327/pdf/v16/i25/3168.pdf

5. http://www.medicareaustralia.gov.au http://www.medicareaustralia.gov.au/...I_24.10.07.pdf Australian Pediatric CDAI Form[/url]© Commonwealth of Australia 2011

6. Crohn's Disease Activity Index, CDAI. Ed. John Prince. 2009. 9, Apr. 2012. http://www.ibdjohn.com/cdai/

7. Panaccione R. The ultimate therapeutic goal: Establishing and maintaining quality of life. Can. J. Gastroenterol. 2004;18(7):465-466.
http://www.pulsus.com/journals/pdf_f...type=Physician

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04-19-2013, 02:06 AM   #1
stefan
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Join Date: Sep 2010
Location: Adelaide, South Australia, Australia
I just noticed this page is linking to www.ibdjohn.com/cdai which may not calculate the CDAI as is expected. This calculator does not weight questions 2 & 3 as much as is commonly accepted, resulting in significantly lower scores than comparing with the typically accepted CDAI, though this lower weighting was based on an earlier version of the index.

A little late perhaps, but as the author of that first calculator page linked (now at www.ibdsupport.org.au/cdai-calculator) I may be able to shed some light on that

My script is written primarily for the Australian Medicare system, which uses a slightly modified CDAI for eligibility for publicly funded access to biologics. However, it turns out all they've done is actually add a maximum deduction of 10 points if you're overweight, which in my script can be disabled with a checkbox next to the weight section.

With the standard CDAI system, remission is typically accepted to be a score below 150, while a score above 300 is considered a flare, but other scores eg 200, 220 or 250 may be used as cutoffs for eligibility to clinical trials etc

The site www.ibdjohn.com/cdai (as used in the wiki) uses an earlier form of the CDAI which is not [as] widely recognised, and results in significantly lower scores than the typically accepted CDAI. That said, it's fine to use and arguably better if all you're after is a relative score to track your progress, but it's not going to directly correlate with the scores that people may use.

The Harvey Bradshaw index is a different scale that I'm not familiar with, but these two do seem to be the most well known and used of the scores for IBD. Though note as the name may suggest, CDAI is not really intended for use in IBDs other than CD, which can be problematic.

Unfortunately all these scales are far from perfect, and as noted by others the CDAI depends heavily on D when most of us may instead suffer from C which is harder to quantify. Also, the "general well-being" section is highly subjective and is responsible for a significant portion of the final score.
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