Inter and intraobserver variability of total skin thickness score (Modified Rodnan TSS) in systemic sclerosis

P. Clements, P. Lachenbruch, J. Siebold, B. White, S. Weiner, R. Martin, A. Weinstein, M. Weisman, M. Mayes, D. Collier, F. Wigley, T. Medsger, V. Steen, L. Moreland, M. Dixon, M. Massa, E. Lally, D. McCloskey, J. Varga

Research output: Contribution to journalArticlepeer-review

724 Scopus citations


Objective. Assessment of the inter and intraobserver variability of the modified Rodnan (m-Rodnan) total skin thickness score by clinical palpation [a commonly used outcome measure in trials of systemic sclerosis (SSc)]. Methods. Skin thickness was assessed by clinical palpation of 17 body areas on a 0 to 3 scale (normal, mild, moderate, severe). The m-Rodnan total skin thickness score was derived by summation of the scores from all 17 body areas. Using the m-Rodnan, 6-7 investigators assessed skin thickness in 5-6 patients with SSc (22 patients and 23 examiners total) at each of 4 sessions for the determination of interobserver variability (accuracy). In addition 21 of the investigators then assessed m-Rodnan in 2-3 patients each (60 patients total) 3 times over a 2-8 week period to quantitate intraobserver variability (reliability). Results. Interobserver and intraobserver mean ± within patient standard deviations (SD) for the m-Rodnan were found to be 17.7 ± 4.6 and 20.7 ± 2.45, respectively. Conclusion. The m-Rodnan total skin thickness score is at least as reliable for measuring skin thickness in SSc as are the ARA and Ritchie joint tenderness counts for assessing joint disease in rheumatoid arthritis. These data are useful for the determination of sample size and for the definitions of clinically meaningful response. Assessment of skin score is sufficiently reproducible to include as a measure of disease outcome, especially if patients are serially evaluated by the same investigator.

Original languageEnglish (US)
Pages (from-to)1281-1285
Number of pages5
JournalJournal of Rheumatology
Issue number7
StatePublished - 1995
Externally publishedYes


  • Scleroderma
  • Skin score
  • Skin thickness
  • Systemic sclerosis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology


Dive into the research topics of 'Inter and intraobserver variability of total skin thickness score (Modified Rodnan TSS) in systemic sclerosis'. Together they form a unique fingerprint.

Cite this