Validation of Simplified Scoring Systems for Assessing Cutaneous Disease Activity in Dermatomyositis

Oct 2, 2026

Objective: Validate simplified Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity scoring versions for dermatomyositis (DM), reducing the training burden of the clinician-scored standard. Methods: Prospectively enrolled adult DM patients completed two visits ≥2 months apart; two rheumatologists scored CDASI activity and MDAAT cutaneous visual analogue scale, and patients filled Skindex. Four sCDASI versions were derived. Results: Twenty-seven patients were analyzed; all simplifications strongly correlated with full CDASI, MDAAT VAS, and Skindex, with high inter-rater reliability and good responsiveness. Conclusion: Preliminary evidence supports validity, reliability, and responsiveness for longitudinal rash assessment.

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CategoryHealthcare

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Abstract

Objective

Methods

Results

Conclusion

Introduction

Background on dermatomyositis and CDASI

Key terms

Validation of simplified scoring systems for assessing cutaneous disease activity in dermatomyositis N. Pongtarakulpanit 1,2 , A. Bishnoi3 , T. Chandra 1 , S. Dzanko 1 , E. Gkiaouraki 1 , S. Keret4 , R. Lomanto Silva5 , S. Sriram 1 , D. Saygin6 , V.M. Liarski 1 , D.P. Ascherman 1 , S. Moghadam-Kia 1 , C.V. Oddis 1 , R. Aggarwal 1 | 1Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Division of Allergy, Immunology and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Dermatology, UPMC, Pittsburgh, PA, USA; 4Rheumatology, Bnai-Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel; 5Department of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, MA, USA; 6Rush University Medical Center, Division of Rheumatology, Chicago, IL, USA. | | --- | | Abstract
Objective
The Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) is a standard clinician-scored outcome measure for dermatomyositis (DM), but requires expertise and training. We aimed to validate simplified versions of
the CDASI activity score . | | Methods
Adult DM patients were prospectively enrolled with two clinic visits ≥2 months apart. Two rheumatologists independently assessed patients using the CDASI activity score (range 0–100) and the cutaneous visual analogue scale of the Myositis Disease Activity Assessment Tool (MDAAT cutaneous VAS). Additionally, patients completed the Skindex questionnaire . Four simplifications (sCDASI) were derived: (1) sCDASI-1 (range 0–66), simplified erythema to absent/present (0–1); (2) sCDASI-2 (range 0–36), simplified erythema and exclusion of scale scoring;
(3) sCDASI-3 (range 0–20), simplified erythema, exclusion of scale and ulcer scoring; (4) sCDASI-4,(range 0–50),
simplification of all parameters to absent/present. | | Results
Twenty-seven DM patients (81.5% female, 96.3% White, median age 50.0) were included. Median CDASI activity was 4.5 (IQR 1.0–12.0). All sCDASI scores correlated strongly with the full CDASI (Spearman ρ=0.97–0.98), MDAAT cutaneous VAS (Spearman ρ=0.94), and Skindex (Spearman ρ=0.82–0.83), indicating good convergent validity. Inter-rater reliability for all simplifications was high, as indicated by strong correlations between assessors . The changes from baseline in simplified CDASI scores correlated strongly with the changes infull CDASI scoresand MDAAT cutaneous VAS, demonstrating good responsiveness. | | Conclusion
Simplified CDASI scorings demonstrated preliminary evidence offavourable validity, reliability, and responsiveness
in the longitudinal evaluation of rashes in DM patients. | | Key words
dermatomyositis, CDASI score, simplification, skin diseases, outcome assessment | Clinical and Experimental Rheumatology 2026; 44: 330-338. Simplified CDASI for cutaneous DM / N. Pongtarakulpanit et al. Nantakarn Pongtarakulpanit, MD Anuradha Bishnoi, MD Tanya Chandra, MD Sedin Dzanko, BS Eugenia Gkiaouraki, MD Shiri Keret, MD Raisa Lomanto Silva, MD Shreya Sriram, MD Didem Saygin, MD Vladimir M. Liarski, MD, MSc Dana P. Ascherman, MD Siamak Moghadam-Kia, MD, MPH Chester V. Oddis, MD RohitAggarwal, MD, MS Please address correspondence to: RohitAggarwal Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3601 Fifth Ave . , Suite 2B, Pittsburgh, PA 15213, USA. [E-mail: aggarwalr@upmc.edu](E-mail: aggarwalr@upmc.edu)[ ](E-mail: aggarwalr@upmc.edu)Received on June 18, 2025; accepted in revised form on January 12, 2026.© Copyright CliniCal and ExpErimEntal rhEumatology2026. Competing interests: D. Saygin is supported by the Rheumatology Research Foundation Scientist Development Award, Rukel Foundation, C-COMP pilot grant, and Rush Pilot Award. She has received consultancies from ArgenX (to institut

FAQs

What was the main objective of the study?

To validate simplified versions of the CDASI activity score for assessing cutaneous disease activity in dermatomyositis.

How were the simplified CDASI versions (sCDASI) created?

Four simplifications were derived from CDASI by selectively reducing scoring elements, such as simplifying erythema to absent/present and excluding scale and ulcer components, culminating in an all-parameters absent/present version (sCDASI-4).

What evidence supports validity and reliability of the simplified scores?

All sCDASI scores showed strong correlations with the full CDASI, MDAAT cutaneous VAS, and Skindex, and inter-rater reliability was high with strong correlations between assessors.

Oct 2, 2026

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