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 Anatomical location: Upper Back & Shoulders Posterior Neck ACTIVITY Erythema: Neither dark or purple, nor pink or faint Red (2) Scale and Ulceration: Absent (0) DAMAGE Poikiloderma: Present (1) Calcinosis: Absent (0) 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) CDASI Anatomical location: Scalp, Malar, Periorbital, V-area of neck ACTIVITY Erythema: Dark red; purple (3) Scale or Ulceration: Absent (0) DAMAGE Poikiloderma: Present on V-area (1) Calcinosis: Absent (0) Copyright © 2011 University of Pennsylvania

(4) CDASI Anatomical location: Periungual ACTIVITY Periungual Changes: Visible telangectasias (2) Copyright © 2011 University of Pennsylvania

(5) CDASI Anatomical location: Arm All Secondary to LIVEDO (non-specific) ACTIVITY Erythema: Absent (0) Scale: Ulceration: 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) CDASI Anatomical 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 DAMAGE 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