The reliability of the Cutaneous Dermatomyositis Disease Area and Severity Index ( CDASI ) among dermatologists, rheumatologists and neurologists

Abstract

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.

Update on dermatomyositis in adults

“…This assessment The Cutaneous Disease Area Severity Index (CDASI) was developed in order to provide systematic documentation of skin involvement in dermatomyositis. has been proven as valid regarding treatment response, also for rheumatologists and neurologists [16,17]. A DM patient's quality of life is correlated with the results found in this index [18].…”

Expanding the use of the Cutaneous Dermatomyositis Area and Severity Index (CDASI) to nondermatologists

“…Until now, the reliability and validity of the CDASI has been demonstrated for dermatologists alone. The results from this study extend the use of this instrument to nondermatologists and represent a meaningful step towards ensuring the inclusion of skin disease outcomes with respect to treatment response in all future DM‐centred investigations, whether led by dermatologists or not. This and other similar efforts provide a platform for the systematic evaluation of novel and repurposed therapies for rare autoimmune and inflammatory diseases that involve the skin.…”

“…In this issue of the BJD , Tiao et al . assessed the reliability of the CDASI when used by dermatologists, rheumatologists and neurologists, the latter two groups representing specialists who also routinely care for patients with DM and participate in DM clinical trials.…”

Transposition Flap for Cutaneous Lesion Coverage in Dermatomyositis

“…Cutaneous ulcerations commonly occur over Gottron papules or in areas with the Gottron sign, and often affect the skin over the extensor joint surfaces, although they could be found anywhere [6]. An evaluation of the lesions using objective measurements, such as the Cutaneous Dermatomyositis Disease Area and Severity Index, is useful for checking the severity of the lesions and assessing their response to treatment [7].…”