Rheumatology Advance Access originally published online on July 16, 2003
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Rheumatology 2003; 42: 1559-1563
© 2003 British Society for Rheumatology
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Seventeen-point dermal ultrasound scoring system—a reliable measure of skin thickness in patients with systemic sclerosis
1University of Manchester Rheumatic Diseases Centre and 2Radiology Directorate, Hope Hospital, Salford M6 8HD and 3ARC Epidemiology Unit, University of Manchester M13 9PT, UK.
Correspondence to:
A. Herrick, University of Manchester Rheumatic Diseases Centre, Clinical Sciences Building, Hope Hospital, Salford M6 8HD. E-mail: aherrick{at}fs1.ho.man.ac.uk
Objective. Our objective was to develop a 17-site ultrasound method of measuring skin thickness in patients with systemic sclerosis (SSc) and to assess its inter- and intra-observer variability.
Methods. Dermal thickness (using a 22 MHz ultrasound probe) was measured at 17 sites (corresponding to those assessed in the modified Rodnan skin score) in 39 patients with SSc (26 limited cutaneous, 13 diffuse) and 34 healthy controls. The sum of the thicknesses (at the 17 sites) and the maximal thickness were also documented. Because skin thickness varies between sites, each measurement was converted to a z-score. Inter- and intra-observer variability were assessed in 35 patients/33 controls, and 20 patients/15 controls respectively.
Results. Measurement precision was good for the dermal measurements—intraclass correlation coefficients at the 17 sites ranged from 0.65 to 0.94 for the inter-observer variability (0.86 for maximum thickness) and from 0.55 to 0.96 for the intra-observer variability (0.92 for maximum thickness).
Conclusion. Our results suggest that the 17-point dermal ultrasound scoring system is extremely reliable and may therefore be a useful measure of outcome, including in clinical trials.
KEY WORDS: Scleroderma, Skin score, Dermal ultrasound.
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