CDASI Training Tool

Victoria P. Werth, M.D.University of Pennsylvania

Copyright © 2011 University of Pennsylvania

Purpose

• Prerequisite for realistically powered trials• Need a tool to measure improvement of disease

for clinical use and for dermatology trials • Need a precise and reliable outcome measure for

Dermatomyositis (DM)– Reliable, consistent, (high interrater and intrarater

reliability)– Validity/sensitivity

Copyright © 2011 University of Pennsylvania

Design Issues

• Quick to use• High inter-rater & intra-rater reliability– Easy to use

• What this means– Describe a few clear symptoms:

e.g. erythema to reflect activity,dyspigmentation to reflect damage

– No attempt to assess percentage clinically

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CDASI use

• Rate the worst score for each body area listed in the CDASI– If some areas on the arm are pink and some are red,

then rate the arm as red.– One area on the arm may be red and a different area

may be scaly. Rate the worst area for each attribute.• If there are papules (elevations in skin, not just

flat macules) in the Gottron‘s area on the hands, then the score for the worst area (pink, red, or dark red) is doubled.

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(1) CDASI

ACTIVITY

Erythema:

• Neither dark or purple, nor pink or faint

• Red (2)

Scale and Ulceration:

• Absent (0)

DAMAGE

Poikiloderma:

• Present (1)

Calcinosis:

• Absent (0)

Anatomical location:

• Upper Back & Shoulders

• Posterior Neck

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(2) CDASI Anatomical location:

• Gottron‘s - Not on Hands

ACTIVITY

Erythema:

• Pink; faint erythema (1)

Scale:

• Scale (1)

Ulceration:

• Absent (0)

DAMAGE

Poikiloderma, Calcinosis:

• Absent (0)

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(3) CDASIAnatomical location:

• Scalp, Malar, Periorbital, V-area of neck

DAMAGE

Poikiloderma:

• Present on V-area (1)

Calcinosis:

• Absent (0)

ACTIVITY

Erythema:

• Dark red; purple (3)

Scale or Ulceration:

• Absent (0)

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(4) CDASI

ACTIVITY

Periungual Changes:

• Visible telangectasias (2)

Anatomical location:

• Periungual

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(5) CDASIAnatomical location:

• Arm

All Secondary to LIVEDO (non-specific)

ACTIVITY

Erythema:

• Absent (0)

Scale:

• Absent (0)

Ulceration:

• Absent (0)

DAMAGE

Poikiloderma:

• Absent (0)

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(6) CDASI

Anatomical location:

• Scalp

ACTIVITY

Erythema:

• Pink (1)

Scale or Ulceration:

• Absent (0)

Alopecia:

• Recent hair loss (last 30 days): Absent or Present?

DAMAGE

Poikiloderma, Calcinosis:• Absent (0)

Copyright © 2011 University of Pennsylvania

(7) CDASIAnatomical location:

• Abdomen

ACTIVITY

Erythema:

• Dark red; purple (3)

Scale or Ulceration:

• Absent (0)

DAMAGE

Poikiloderma:

• Present (1)

Calcinosis:

• Absent (0)

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(8) CDASI

Anatomical location:

• Periorbital

ACTIVITY

Erythema:

• Not red or dark-red

• Pink (1)

Scale or Ulceration:

• Absent (0)

DAMAGE

Poikiloderma, Calcinosis:

• Absent (0)

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(9) CDASI

Anatomical location:

• Gottron‘s – Hands

• Dorsum of Hands (not over joints)

ACTIVITY

• Pink; faint erythema (1)

• If papules present, then double score

• Ulceration absent (0)

DAMAGE

• Absent (0)

Copyright © 2011 University of Pennsylvania

References for CDASI Validation Studies

• Klein RQ, Bangert CC, Costner M, Connolly MK, Dugan, Tanikawa EA, Okawa J, Rose M, Fakharzadeh SS, Fiorentino D, Lee LA, Sontheimer RD, Taylor L, Troxel AB, Werth VP. The CDASI, DSSI, & CAT: Comparison of reliability and validity in the development of an outcome instrument for cutaneous dermatomyositis. Br J Dermatol 159:887-894, 2008.

• Yassaee M, Fiorentino D, Taylor L, Okawa J, Werth VP. Modification of the Cutaneous Dermatomyositis Disease Area and Severity Index, an outcome measure instrument. Br J Dermatol 162: 669-73, 2010.

Copyright © 2011 University of Pennsylvania

References for CDASI Validation Studies

• Chock M, Goreshi R, Werth VP, Fiorentino D. Quantitative assessment of disease severity in dermatomyositis. J Invest Dermatol (abstr), 130 (Suppl 1): S50, 2010.

• Goreshi R, Okawa J, Rose M, Taylor L, Lee L, Hansen C, Bangert C, Connolly K, Davis M, Callen J, Fett N, Fakharzadeh S, Clarke J, Werth VP. Evaluation of reliability, validity, and responsiveness of the CDASI, CAT-BM, and the CAT-MM. J Invest Dermatol, 2012; 132(4):1117-24.

Copyright © 2011 University of Pennsylvania