Developing classification criteria for skin-predominant dermatomyositis: the Delphi process. The British journal of dermatology Concha, J. S., Pena, S. n., Gaffney, R. G., Patel, B. n., Tarazi, M. n., Kushner, C. J., Merola, J. F., Fiorentino, D. n., Dutz, J. P., Goodfield, M. n., Nyberg, F. n., Volc-Platzer, B. n., Fujimoto, M. n., Ang, C. C., Werth, V. P. 2019


The European League Against Rheumatism / American College of Rheumatology (EULAR / ACR) classification criteria for inflammatory myopathies are able to classify patients with skin-predominant dermatomyositis (DM). However, approximately 25% of patients with skin-predominant DM do not meet 2 out of the 3 hallmark skin signs and fail to meet the criteria.We aim to develop a set of skin-focused classification criteria that will distinguish cutaneous DM from mimickers and allow a more inclusive definition of skin-predominant disease.An extensive literature review was done to generate items for the Delphi. Items were grouped into categories of distribution, morphology, symptoms, antibodies, histology, and contextual factors. Using REDCap™ , participants rated these items in terms of appropriateness and distinguishing ability from mimickers. The relevance score ranged from 1 to 100, and the median score determined a rank-ordered list. A pre-specified median score cut-off was decided by the steering committee and the participants. There was a pre-Delphi and two rounds of actual Delphi.There were 50 participating dermatologists and rheumatologists from North America, South America, Europe, and Asia. After a cutoff score of 70 during the first round, 37 out of the initial 54 items were retained and carried over to the next round. The cutoff was raised to 80 during round two, and a list of 25 items was generated.This project is a key step in the development of prospectively validated classification criteria that will create a more inclusive population of DM patients for clinical research. This article is protected by copyright. All rights reserved.

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