title: 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 patients with DM and assess skin activity in clinical trials.
  
  
  OBJECTIVE
  To assess the reliability of the CDASI among dermatologists, rheumatologists and neurologists.
  
  
  METHODS
  Fifteen patients with cutaneous DM were assessed using the CDASI and the Physician Global Assessment (PGA) by five dermatologists, five rheumatologists and five neurologists.
  
  
  RESULTS
  The mean CDASI activity scores for dermatologists, rheumatologists and neurologists were 21·0, 21·8 and 20·8, respectively. These mean scores 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 mean scores between dermatologists and rheumatologists were significantly different, but the means between dermatologists and neurologists were not. The intraclass correlation coefficients (ICCs) for interrater reliability for CDASI activity and damage were good to excellent for dermatologists and rheumatologists, and moderate to excellent for neurologists. The ICCs for intrarater reliability for CDASI activity and damage were excellent for dermatologists and rheumatologists and moderate to excellent for neurologists. The PGA displayed lower interrater and intrarater reliability relative to the CDASI.
  
  
  CONCLUSIONS
  Our results confirm the reliability of the CDASI when used by dermatologists and rheumatologists. The data for its use by neurologists were not as robust.
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.|Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Tiao
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: R
authors.initials: R
authors.lastname: Feng
authors.affiliation: Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: S
authors.initials: S
authors.lastname: Bird
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.|Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A.
authors.forename: J K
authors.initials: JK
authors.lastname: Choi
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Dunham
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: M
authors.identifier: http://orcid.org/0000-0002-0398-2308
authors.initials: M
authors.lastname: George
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.|Department of Neurology, GlaxoSmithKline USA, Philadelphia, PA, U.S.A.
authors.forename: T C
authors.initials: TC
authors.lastname: Gonzalez-Rivera
authors.affiliation: Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: J L
authors.initials: JL
authors.lastname: Kaufman
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.|Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A.
authors.forename: N
authors.initials: N
authors.lastname: Khan
authors.affiliation: Department of Neurology, Temple University School of Medicine, Philadelphia, PA, U.S.A.
authors.forename: J J
authors.initials: JJ
authors.lastname: Luo
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: R
authors.initials: R
authors.lastname: Micheletti
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: A S
authors.initials: AS
authors.lastname: Payne
authors.affiliation: Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: R
authors.initials: R
authors.lastname: Price
authors.affiliation: Department of Neurology Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: C
authors.initials: C
authors.lastname: Quinn
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: A I
authors.initials: AI
authors.lastname: Rubin
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: A G
authors.initials: AG
authors.lastname: Sreih
authors.affiliation: Division of Rheumatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: P
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.
authors.forename: J
authors.initials: J
authors.lastname: Okawa
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.|Corporal Michael J. Crescenz Veterans Affairs Medical Center (Philadelphia), Philadelphia, PA, U.S.A.
authors.forename: V P
authors.initials: VP
authors.lastname: Werth
mesh_terms: D000704:Analysis of Variance; D000072085:Dermatologists; D003882:Dermatomyositis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072141:Neurologists; D015588:Observer Variation; D015203:Reproducibility of Results; D000072140:Rheumatologists; D012720:Severity of Illness Index