Clinical Rheumatology

, Volume 33, Issue 2, pp 207–214 | Cite as

Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis

  • Murray Baron
  • Lorinda Chung
  • Geneviève Gyger
  • Laura Hummers
  • Dinesh Khanna
  • Maureen D. Mayes
  • Janet E. Pope
  • Ami A. Shah
  • Virginia D. Steen
  • Russell Steele
  • Solène Tatibouet
  • Ariane Herrick
  • Ulf Müller-Ladner
  • Marie Hudson
Original Article

Abstract

The objectives of this study were to develop a standard classification of digital ulcers (DUs) in systemic sclerosis (SSc) for use in observational or therapeutic studies and to assess the reliability of these definitions as well as of the measurement of ulcer area. Ten North American rheumatologists with expertise in SSc reviewed multiple photos of DUs, examined four SSc subjects with DUs, and came to a consensus on the definitions for digital, active, healed, and indeterminate ulcers. These ten raters then examined the right hand of ten SSc subjects twice and the left hand once to classify ulcers and to measure ulcer area. Weighted and Fleiss kappa were used to calculate intra- and interrater agreement on classification of ulcers, and intraclass correlation coefficient (ICC) was used to assess agreement on ulcer area. Because the traditional ICC calculations relied on a small number of ulcers, ICCs were recalculated using the results of linear mixed models to evaluate the variance components of observations on all the data. Intrarater kappa for classifying DU as not an ulcer/healed ulcer versus active/indeterminate ulcer was substantial (0.76), and interrater kappa was moderate (0.53). The ICC for ulcer area using the linear mixed models was moderate both for intrarater (0.57) and interrater (0.48) measurements. A consensus for the classification of DUs in SSc was developed, and after a training session, rheumatologists with expertise in SSc are able to reliably classify DUs and to measure ulcer area.

Keywords

Digital ulcers Ischemia Psychometrics Reliability Scleroderma Systemic sclerosis 

Supplementary material

10067_2013_2460_MOESM1_ESM.doc (28 kb)
ESM 1(DOC 28 kb)

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Copyright information

© Clinical Rheumatology 2013

Authors and Affiliations

  • Murray Baron
    • 1
  • Lorinda Chung
    • 2
  • Geneviève Gyger
    • 1
  • Laura Hummers
    • 3
  • Dinesh Khanna
    • 4
  • Maureen D. Mayes
    • 5
  • Janet E. Pope
    • 6
  • Ami A. Shah
    • 3
  • Virginia D. Steen
    • 7
  • Russell Steele
    • 8
  • Solène Tatibouet
    • 1
  • Ariane Herrick
    • 9
  • Ulf Müller-Ladner
    • 10
    • 11
  • Marie Hudson
    • 1
  1. 1.Division of RheumatologyJewish General HospitalMontrealCanada
  2. 2.Immunology and RheumatologyStanford UniversityStanfordUSA
  3. 3.John Hopkins UniversityBaltimoreUSA
  4. 4.Internal Medicine, Division of RheumatologyUniversity of MichiganAnn ArborUSA
  5. 5.Internal Medicine, Division of Rheumatology and Clinical ImmunogeneticsUniversity of TexasAustinUSA
  6. 6.St. Joseph’s HospitalUniversity of Western OntarioLondonCanada
  7. 7.Georgetown UniversityWashingtonUSA
  8. 8.Department of Mathematics and StatisticsMcGill UniversityMontréalCanada
  9. 9.University of ManchesterManchesterUK
  10. 10.Internal Medicine and RheumatologyJustus-Liebig UniversityGiessenGermany
  11. 11.Department of Rheumatology and Clinical ImmunologyKerckhoff-KlinikBad NauheimGermany

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