NO COPYModified Rodnan skin score - EUSTAR
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Modified Rodnan skin score Yannick Allanore Paris Descartes University France NO COPY
Transcript of NO COPYModified Rodnan skin score - EUSTAR
Modified Rodnanskin score
Yannick Allanore
Paris Descartes UniversityFranceNO C
OPY
ACR/EULAR 2013 CRITERIA
Van den Hoogen et al. Ann Rheum Dis. 2013;72:1747-55.
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• Normal epidermis• Thickened dermis with disorganised collagen
• Decrease in adnexal structures• Reduced surrounding adipose tissue• Perivascular lymphocytic infiltrate
• In red, the dermal thickness
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Measurement of skin thickness
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A remettre à Carole DESBAS - Sécrétaire du Pr. ALLANORE - Hardy A3 - Merci
Modified Rodnan Skin ScoreDate : ……../……../20……
0 1 2 3
0 1 2 3 0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3
0 1 2 3 0 1 2 3
0 1 2 3 0 1 2 3
0 1 2 3 0 1 2 3
0 1 2 3 0 1 2 3
0 1 2 3 0 1 2 3
Patient name
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The OMERACT Filter for Outcome Measure Validation
Face Validity : does it make sense?
Content Validity : is it comprehensive?
Construct validity : agree with other measures or with a “gold standard”? –
ability to discriminate subsets?
Accuracy - criterion validity
Discrimination. Does the measure discriminate between situations of interest?
Reproducibility
Sensitivity to change
Feasibility: Can the measure be applied easily, given constraints of time, money,
and interpretability?
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mRSS : a valid outcome measure
• Accuracy: Inter-observer variability 5 units (20-25%)
• Reproducibility: Intra-observer variability 3 units (10-15%)
• Accessibility: Clinical examination technique
• Construct validity: good correlation with skin biopsies (weight and histology)
• Sensitivity to Change: Characteristic
Furst DE et al. J Rheumatol 1998; 25: 84-8
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Verrecchia et al. Rheumatology (Oxford). 2007;46:833-41
Correlation between 3 histological sub-groups and the mRSS
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Shand et al. Arthritis Rheum. 2007;56(7):2422-31
SSc subsets according to cutaneous changes
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Shand et al. Arthritis Rheum. 2007;56(7):2422-31
SSc subsets according to cutaneous changes
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Perera et al. Arthritis Rheum. 2007;56(8):2740-6.
SSc subsets according to cutaneous changes
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Perera et al. Arthritis Rheum. 2007;56(8):2740-6.
SSc subsets according to cutaneous changes
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DeMarco PJ et al. Arthritis Rheum 2002
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Prediction of renal crisis in D-Pen trial (n=18/133)
Variable OR 95% CI p-value
Skin Score >20 10.00 2.213-45.907 0.003
Large Joint
Contracture
16.12 2.075-25.254 0.008
Prednisone Use 3.63 1.304-10.051 0.014
Heart involvement 2.93 1.010-8.482 0.048
DeMarco PJ et al. Arthritis Rheum 2002
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mRSS and disability: D-Pen study
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
0.4
Jt Tender HAQ-DI
-0.9
-0.29
0.4
0.05
Improved
Not-Impr
DeMarco PJ et al. Arthritis Rheum 2002
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mRSS : a valid outcome measure
• Increase in mRSS predicts worsening of SSc
• Stability in mRSS predicts reduced new internal involvement
• Improvement in mRSS predicts improved survival
• High scores (>20) predict renal crisis
• High scores (>20) predict mortality
• Improved mRSS correlates with joint involvement, hand function, QOL (HAQ-DI)
Clements PJ, et al. Arthritis Rheum. 1990 and 2000. Steen and Medsger. Arthritis Rheum 2001.
.
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Skin thickness progression rate: a predictor of mortalityand early internal organ involvement in DcSSc
STPR = mRSS at the 1st visit divided by the duration of skin thickening (in years)
Domsic et al. Ann Rheum Dis. 2011;70:104-9
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Plot of Individual Patient mRSS over Time
Merkel et al. Arthritis Rheum. 2012;64:3420-9
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Duration of disease in dcSSc at peak
skin score
010203040506070
<6 6 to
12
12
to
18
18
to
24
24
to
30
30
to
36
36
to
42
42
to
48
48
to
54
54
to
60
60
to
66
66
to
72
disease duration (months)
nu
mb
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of
cases
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Cohort enrichment: skin
Maurer et al. Ann Rheum Dis. 2015;74:1124-31
637 dcSSc patients with longitudinal mRSS data
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mRSS as an outcome measure
• Good performance metrics and validated in early DcSSc
• Surrogate for internal organs and it can predict outcomes
• But not linear regarding the natural history and some patient dependance (distinct subsets and role of auto-antibodies)
• High inter-individual variability for scoring
• Various targeted population according to the goal of the trials: regression versus prevention of progressionNO C
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