ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 295

Reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index Among Dermatologists, Rheumatologists, and Neurologists

Neelam Khan1,2, Janice Tiao1,2, Rui Feng3, Shawn Bird4, Juliana Choi1, Michael George5, Tania Gonzalez-Rivera5, Jacob L. Kaufman4, Jin Jun Luo6, Robert Micheletti1, Aimee S. Payne1, Raymond Price4, Adam I. Rubin7, Antoine G. Sreih8, Preethi Thomas5, Joyce Okawa7 and Victoria P. Werth1,9, 1Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, 2Philadelphia V.A. Medical Center, Philadelphia, PA, 3Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, 4Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, 5Department of Rheumatology, Hospital of the University of Pennsylvania, Philadelphia, PA, 6Department of Neurology, Temple University School of Medicine, Philadelphia, PA, 7Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 8Department of Rheumatology, University of Pennsylvania, Philadelphia, PA, 9Philadelphia V.A. Medical Center, Philidelphia, PA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords:

Session Information

Date: Sunday, November 8, 2015

Title: Muscle Biology, Myositis and Myopathies Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Previous studies have shown that skin lesions in dermatomyositis (DM) are best assessed using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). Although the CDASI has been validated for use by dermatologists, it has not yet been validated for use by other specialists such as rheumatologists and neurologists, who also manage DM patients and evaluate their skin in clinical trials. The purpose of this study is to assess the inter-rater and intra-rater reliability of the CDASI and extend the validation of the CDASI to rheumatologists and neurologists.

Methods: Five dermatologists, five rheumatologists, and five neurologists specializing in neuromuscular medicine individually assessed 15 patients with cutaneous DM using the CDASI and the Physician’s Global Assessment (PGA). All physicians received a 30-minute training session on the CDASI and PGA prior to evaluating patients. Each physician also re-rated three patients. Intraclass correlation (ICC) scores <0.5 were considered poor, 0.50 to 0.70 moderate and minimally acceptable, 0.70 to 0.81 good, and >0.81 excellent.

Results: Inter-rater reliability yielded an ICC for CDASI activity that was good for dermatologists and rheumatologists (0.73 and 0.74, respectively) and moderate for neurologists (0.56). The ICC for CDASI damage was excellent for all physicians (dermatologists 0.83, rheumatologists 0.82, neurologists 0.85). For PGA activity, the ICC was moderate for dermatologists (0.61) and rheumatologists (0.69) but poor for neurologists (0.44). The ICC for PGA damage was excellent for neurologists (0.85), good for rheumatologists (0.75), and moderate for dermatologists (0.58) (Table 1).

Intra-rater (test-retest) reliability for CDASI activity was excellent for all physicians (dermatologists 0.94, rheumatologists 0.88, neurologists 0.82). For CDASI damage the scores were excellent for dermatologist and rheumatologists (0.92 and 0.91, respectively) and moderate for neurologists (0.66). For the PGA activity and damage the intra-rater reliability was excellent for dermatologists (0.89 and 0.91, respectively) and good for rheumatologists (0.75 and 0.75, respectively). For neurologists, the PGA activity was good (0.74) but the PGA damage was poor (0.39) (Table 2).

Conclusion: Our data confirm the reliability of the CDASI when used by dermatologists and support the CDASI as a reliable instrument for use by rheumatologists. The data was not as robust for its use by neurologists.

Table 1. Inter-observer correlation coefficient (95% C.I.)

 

Within dermatologists (n=5)

Within rheumatologists

(n=5)

Within neurologists (n=5)

CDASI

 

 

 

Activity

0.73 (0.55-0.90)

0.74 (0.58-0.91)

0.56 (0.33-0.79)

Damage

0.86 (0.76-0.96)

0.82 (0.69-0.94)

0.84 (0.73-0.95)

PGA

 

 

 

Activity

0.61 (0.40-0.83)

0.69 (0.50-0.88)

0.44 (0.19-0.68)

Damage

0.58 (0.46-0.81)

0.75 (0.60-0.91)

0.85 (0.75-0.96)

 

 

 

 

 

 

 

Table 2. Test-retest reliability ICC (95% C.I.)

 

Within dermatologists (n=5)

Within rheumatologists

(n=5)

Within neurologists (n=5)

CDASI

 

 

 

Activity

0.94 (0.88-1.00)

0.88 (0.76-0.99)

0.82 (0.65-0.99)

Damage

0.92 (0.83-1.00)

0.91 (0.82-1.00)

0.66 (0.37-0.95)

PGA

 

 

 

Activity

0.89 (0.79-1.00)

0.75 (0.53-0.97)

0.74 (0.51-0.97)

Damage

0.91 (0.82-1.00)

0.75 (0.53-0.97)

0.39 (0.00-0.82)

Disclosure: N. Khan, None; J. Tiao, None; R. Feng, None; S. Bird, None; J. Choi, None; M. George, None; T. Gonzalez-Rivera, None; J. L. Kaufman, None; J. J. Luo, None; R. Micheletti, None; A. S. Payne, None; R. Price, None; A. I. Rubin, None; A. G. Sreih, Roche/Genentech, 5; P. Thomas, None; J. Okawa, None; V. P. Werth, None.

To cite this abstract in AMA style:

Khan N, Tiao J, Feng R, Bird S, Choi J, George M, Gonzalez-Rivera T, Kaufman JL, Luo JJ, Micheletti R, Payne AS, Price R, Rubin AI, Sreih AG, Thomas P, Okawa J, Werth VP. Reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index Among Dermatologists, Rheumatologists, and Neurologists [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/reliability-of-the-cutaneous-dermatomyositis-disease-area-and-severity-index-among-dermatologists-rheumatologists-and-neurologists/. Accessed .

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