title: International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis.
abstract: OBJECTIVE
  Clinical trials in psoriasis and psoriatic arthritis (PsA) involve assessment of the skin and joints. This study aimed to determine whether assessment of the skin and joints in patients with PsA by rheumatologists and dermatologists is reproducible.
  
  
  METHODS
  Ten rheumatologists and 9 dermatologists from 7 countries met for a combined physical examination exercise to assess 20 PsA patients (11 men, mean age 51 years, mean PsA duration 11 years). Each physician assessed 10 patients according to a modified Latin square design that enabled the assessment of patient, assessor, and order effect. Tender joint count (TJC), swollen joint count (SJC), dactylitis, physician's global assessment (PGA) of PsA disease activity (PGA-PsA), psoriasis body surface area (BSA), Psoriasis Area and Severity Index (PASI), Lattice System Physician's Global Assessment of psoriasis (LS-PGA), National Psoriasis Foundation Psoriasis Score (NPF-PS), modified Nail Psoriasis Severity Index (mNAPSI), number of fingernails with nail changes (NN), and PGA of psoriasis activity (PGA-Ps) were assessed. Variance components analyses were carried out to estimate the intraclass correlation coefficient (ICC), adjusted for the order of measurements.
  
  
  RESULTS
  There is excellent agreement (ICC >/=0.80) on the mNAPSI, substantial agreement (0.6 >/= ICC < 0.80) on the TJC, PASI, and NN, moderate agreement (0.4 >/= ICC < 0.60) on the PGA-Ps, LS-PGA, NPF-PS, and BSA, and fair agreement (0.2 >/= ICC < 0.40) on the SJC, dactylitis, and PGA-PsA. The only measure that showed a significant difference between dermatologists and rheumatologists was dactylitis (P = 0.0005).
  
  
  CONCLUSIONS
  There is substantial to excellent agreement on the TJC, PASI, NN, and mNAPSI among rheumatologists and dermatologists.
authors.affiliation: Toronto Western Hospital, Toronto, Ontario, Canada.
authors.forename: Vinod
authors.initials: V
authors.lastname: Chandran
authors.forename: Alice
authors.initials: A
authors.lastname: Gottlieb
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Kristina Callis
authors.initials: KC
authors.lastname: Duffin
authors.forename: Amit
authors.initials: A
authors.lastname: Garg
authors.forename: Philip
authors.initials: P
authors.lastname: Helliwell
authors.forename: Arthur
authors.initials: A
authors.lastname: Kavanaugh
authors.forename: Gerald G
authors.initials: GG
authors.lastname: Krueger
authors.forename: Richard G
authors.initials: RG
authors.lastname: Langley
authors.forename: Charles
authors.initials: C
authors.lastname: Lynde
authors.forename: Neil
authors.initials: N
authors.lastname: McHugh
authors.forename: Philip
authors.initials: P
authors.lastname: Mease
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.forename: Proton
authors.initials: P
authors.lastname: Rahman
authors.forename: Cheryl F
authors.initials: CF
authors.lastname: Rosen
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.forename: Diamant
authors.initials: D
authors.lastname: Thaci
authors.forename: Sergio M A
authors.initials: SM
authors.lastname: Toloza
authors.forename: Maxine Yat Wing
authors.initials: MY
authors.lastname: Wong
authors.forename: Qian M
authors.initials: QM
authors.lastname: Zhou
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D050823:Hand Joints / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000473:pathology / Q000503:physiopathology*; D015588:Observer Variation; D011565:Psoriasis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology / Q000503:physiopathology*