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The EUSTAR model for teaching and implementing the modified Rodnan skin score in systemic sclerosis
  1. László Czirják (laszlo.czirjak{at}
  1. University of Pecs, Hungary
    1. Zoltan Nagy (zoltan.nagy{at}
    1. Medical University Pecs, Hungary, Hungary
      1. Martin Aringer (martin.aringer{at}
      1. Medical University of Vienna, Austria
        1. Gabriela Riemekasten (gabriela.riemekasten{at}
        1. Charité University Hospital, Germany
          1. Marco Matucci-Cerinic (cerinic{at}
          1. University of Florence, Italy
            1. Daniel E Furst (defurst{at}
            1. Univ of Cal at Los Angeles, United States


              Objective:To evaluate the ability to teach scleroderma experts and young rheumatologists to perform the modified Rodnan skin score (MRSS).

              Design: Several international meetings were organized.

              Subjects: Three international “teaching courses for teachers” were conducted with 6-9 experts who performed 3-9 skin scores each. In addition an international course for 90 young rheumatologists, in which 18 SSc patients participated, was also organized. Finally, a local repeated training course for 5-9 rheumatologists was performed, in which 6-7 SSc patients participated.

              Results: When 6-9 scleroderma specialists investigated the patients, the intraclass correlation coefficient (ICC) showed “good” to “excellent” values (0.865 and 0.710, respectively). When 90 young rheumatologists were involved in one teaching course, the coefficient of variation (CV) was relatively satisfactory (35%) due to the high number of investigators, and with a considerable within patient SD value of 5.4.

              Repeated teaching of 5-9 young rheumatologists in local courses clearly improved consistency. The ICC increased from 0.496 to a “good” level of 0.722. The within patient SD values for intra-observer variability ranged between 2.5-2.9 . The intra-observer CV was about 20%.

              Conclusions: Our study strongly supports the need for standardisation among different centers when using skin scoring for clinical trials. The intra-observer variability and within patient SD values can be significantly reduced by repeated teaching. For inexperienced rheumatologists at least one repeated teaching course is needed.

              • Rodnan skin score
              • scleroderma
              • skin
              • systemic sclerosis

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