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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
Copyright © 2011 University of Pennsylvania
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.
Copyright © 2011 University of Pennsylvania
(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
Copyright © 2011 University of Pennsylvania
(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)
Copyright © 2011 University of Pennsylvania
(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)
Copyright © 2011 University of Pennsylvania
(4) CDASI
ACTIVITY
Periungual Changes:
• Visible telangectasias (2)
Anatomical location:
• Periungual
Copyright © 2011 University of Pennsylvania
(5) CDASIAnatomical location:
• Arm
All Secondary to LIVEDO (non-specific)
ACTIVITY
Erythema:
• Absent (0)
Scale:
• Absent (0)
Ulceration:
• Absent (0)
DAMAGE
Poikiloderma:
• Absent (0)
Copyright © 2011 University of Pennsylvania
(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)
Copyright © 2011 University of Pennsylvania
(8) CDASI
Anatomical location:
• Periorbital
ACTIVITY
Erythema:
• Not red or dark-red
• Pink (1)
Scale or Ulceration:
• Absent (0)
DAMAGE
Poikiloderma, Calcinosis:
• Absent (0)
Copyright © 2011 University of Pennsylvania
(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