title: Impact of training on concordance among rheumatologists and dermatologists in the assessment of patients with psoriasis and psoriatic arthritis.
abstract: To evaluate the impact of training on the reliability among dermatologists and rheumatologists in the assessment of psoriatic arthritis (PsA) patients.
  
  
  
  Overall, 9 hospital-based rheumatologists and 8 hospital-based dermatologists met in Reggio Emilia, Italy on October 2015 to assess 17 PsA patients. After 1 month, physicians underwent a 3-h training session by 4 recognized experts and then assessed 19 different PsA patients according to a modified Latin square design. Measures included tender (TJC) and swollen joint count (SJC), dactylitis, enthesitis, Schober test, psoriasis body surface area (BSA), Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), and static physician's global assessment of PsA disease activity (sPGA). Variance components analyses were performed to estimate the intraclass correlation coefficient (ICC).
  
  
  
  TJC and enthesitis-measured pre-training by dermatologists or rheumatologists revealed moderate-substantial agreement (ICC: 0.4-0.8). In contrast, SJC and Schober test showed fair (ICC: 0.2-0.4) and moderate agreement, respectively (ICC: 0.4-0.6), while poor agreement (ICC: 0-0.2) was represented by dactylitis. Moderate-substantial (ICC: 0.4-0.8) agreement was observed for most skin measures by dermatologists and rheumatologists, apart from BSA, where fair agreement (ICC: 0.2-0.4) was observed. Agreement levels were similar before and after training for arthritis measures. In contrast, levels of agreement after training for 3 of the 4 skin measures were increased for dermatologists and all 4 skin measures were increased for rheumatologists.
  
  
  
  Substantial to excellent agreement was observed for TJC, enthesitis, PASI, and sPGA. Rheumatologists benefited from training to a greater extent.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy; University of Modena and Reggio Emilia, Italy. Electronic address: salvarani.carlo@asmn.re.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
authors.affiliation: Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Girolomoni
authors.affiliation: Dermatology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Di Lernia
authors.affiliation: Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gisondi
authors.affiliation: CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Primula Multimedia SRL, Ospedaletto, Pisa, Italy.
authors.forename: Colin Gerard
authors.initials: CG
authors.lastname: Egan
authors.affiliation: Department of Rheumatology, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000175:diagnosis*; D000072085:Dermatologists / Q000193:education*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011565:Psoriasis / Q000175:diagnosis; D015203:Reproducibility of Results; D000072140:Rheumatologists / Q000193:education*; D012720:Severity of Illness Index
keywords: Assessment; Dermatologist; Joint; Psoriatic arthritis; Rheumatologist; Skin