Impact of EUSTAR standardized training on accuracy of modified Rodnan skin score in patients with systemic sclerosis

Ahn, Ga Young; Kim, Ji-Won; Park, Eun Seong; Kang, Jian; Chang, Sung Hae; Choi, In Ah; Yoo, Su Jin; Park, Jin Kyun; Lee, Shin-Seok; Park, Yong Bum; Jun, Jae Bum; Czirják, László; Allanore, Yannick; Matucci‐Cerinic, Marco; Lee, Eun Bong

doi:10.1111/1756-185x.13433

Cited by 7 publications

(9 citation statements)

References 16 publications

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“…By comparison, in the expert group, the inter-rater agreement did not improve (before 0.5 and after 0.5). Our results agree with previous studies where mRSS assessment accuracy improved with experience [ 15 , 16 , 40 , 41 ]. The inter-rater variability for mRSS assessment using the skin model was good compared to raters who took a standardized mRSS training course [ 40 ].…”

Section: Discussionsupporting

confidence: 93%

Skin model for improving the reliability of the modified Rodnan skin score for systemic sclerosis

et al. 2022

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Background The gold standard for skin thickness assessment in systemic sclerosis (SSc) is the modified Rodnan skin score (mRSS); however, inter- and intra-rater variation can arise due to subjective methods and inexperience. The study aimed to determine the inter- and intra-rater variability of mRSS assessment using a skin model. Methods A comparative study was conducted between January and December 2020 at Srinagarind Hospital, Khon Kaen University, Thailand. Thirty-six skin sites of 8 SSc patients underwent mRSS assessment: 4 times the first day and 1 time over the next 4 weeks by the same 10 raters. No skin model for mRSS assessment was used for the first two assessments, while one was used for the remaining three rounds of assessments. The Latin square design and Kappa statistic were used to determine inter- and intra-rater variability. Results The kappa agreement for inter-rater variability improved when the skin model was used (from 0.4 to 0.5; 25%). The improvement in inter-rater variability was seen in the non-expert group, for which the kappa agreement rose from 0.3 to 0.5 (a change of 66.7%). Intra-rater variability did not change (kappa remained at 0.9), and the long-term effect of using a skin model slightly decreased by week 4 (Δkappa 0.9–0.7). Conclusions Using a skin model could be used to improve inter-rater variation in mRSS assessment, especially in the non-expert group. The model should be considered a reference for mRSS assessment in clinical practice and health education.

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Section: Discussionsupporting

confidence: 93%

Skin model for improving the reliability of the modified Rodnan skin score for systemic sclerosis

et al. 2022

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“…The EUSTAR database contains data on demographic characteristics, disease features, organ damage, laboratory parameters, capillaroscopy, echocardiography, pulmonary function tests (PFTs), and medication. In order to harmonize clinical practices and ensure reliable evaluation of parameters among centers, EUSTAR arranges regular training courses and edits SSc management guidelines .…”

Section: Methodsmentioning

confidence: 99%

Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis

Sobanski

Giovannelli

Allanore

et al. 2019

Arthritis & Rheumatology

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Objective Systemic sclerosis (SSc) is a heterogeneous connective tissue disease that is typically subdivided into limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) depending on the extent of skin involvement. This subclassification may not capture the entire variability of clinical phenotypes. The European Scleroderma Trials and Research (EUSTAR) database includes data on a prospective cohort of SSc patients from 122 European referral centers. This study was undertaken to perform a cluster analysis of EUSTAR data to distinguish and characterize homogeneous phenotypes without any a priori assumptions, and to examine survival among the clusters obtained. Methods A total of 11,318 patients were registered in the EUSTAR database, and 6,927 were included in the study. Twenty‐four clinical and serologic variables were used for clustering. Results Clustering analyses provided a first delineation of 2 clusters showing moderate stability. In an exploratory attempt, we further characterized 6 homogeneous groups that differed with regard to their clinical features, autoantibody profile, and mortality. Some groups resembled usual dcSSc or lcSSc prototypes, but others exhibited unique features, such as a majority of lcSSc patients with a high rate of visceral damage and antitopoisomerase antibodies. Prognosis varied among groups and the presence of organ damage markedly impacted survival regardless of cutaneous involvement. Conclusion Our findings suggest that restricting subsets of SSc patients to only those based on cutaneous involvement may not capture the complete heterogeneity of the disease. Organ damage and antibody profile should be taken into consideration when individuating homogeneous groups of patients with a distinct prognosis.

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“…The long duration of the study and the turnover of the investigators could have led to a high variability in mRSS. However, all participating centers are SSc referral centers in which physicians attend regular mRSS assessment training, which might have reduced this limitation [38,39]. Fifth, the start and end dates for each immunosuppressive drug in parallel to mRSS assessments were lacking in the database.…”

Section: Discussionmentioning

confidence: 99%

Early trajectories of skin thickening are associated with severity and mortality in systemic sclerosis

et al. 2020

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Background: Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival.Methods: From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes. Results: A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1-6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2-5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5. Conclusions: Early identification of clinical phenotype based on skin thickening trajectories could predict morbimortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.

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Impact of EUSTAR standardized training on accuracy of modified Rodnan skin score in patients with systemic sclerosis

Cited by 7 publications

References 16 publications

Skin model for improving the reliability of the modified Rodnan skin score for systemic sclerosis

Skin model for improving the reliability of the modified Rodnan skin score for systemic sclerosis

Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis

Early trajectories of skin thickening are associated with severity and mortality in systemic sclerosis

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