Objective. To evaluate the validity of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) for use by rheumatologists via reliability testing, and to extend the validation for dermatologists. Methods. Fourteen subjects with cutaneous lupus erythematosus (CLE; n ‫؍‬ 10), a mimicker skin disease only (a cutaneous lesion that may appear clinically similar to CLE; n ‫؍‬ 1), or both (n ‫؍‬ 3) were rated with the CLASI by academic-based dermatologists (n ‫؍‬ 5) and rheumatologists (n ‫؍‬ 5). Results. The dermatology intraclass correlation coefficient (ICC) was 0.92 for activity and 0.82 for damage; for rheumatology the ICC was 0.83 for activity and 0.86 for damage. For intrarater reliability, the dermatology Spearman's rho was 0.94 for activity and 0.97 for damage; for rheumatology the Spearman's rho was 0.91 for activity and 0.99 for damage. Conclusion. Our data confirm the reliability of the CLASI when used by dermatologists and support the CLASI as a reliable instrument for use by rheumatologists.

Background Previous studies have shown that skin disease in dermatomyositis (DM) is 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 been validated for use by other physicians such as rheumatologists and neurologists, who also manage DM patients and assess skin activity in clinical trials. The purpose of this study is to assess the reliability of the CDASI among dermatologists, rheumatologists, and neurologists. Methods Fifteen subjects with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists, and five neurologists. Results The CDASI activity score means for dermatologists, rheumatologists, and neurologists were 21.0, 21.8, and 20.8, respectively. These means were not different among the specialists. The CDASI damage score means for dermatologists, rheumatologists, and neurologists were 5.3, 7.0, and 4.8, respectively. The means between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for inter-rater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intra-rater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower inter-rater and intra-rater reliability relative to the CDASI. Conclusions Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data was not as robust for its use by neurologists.

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