Reliability of the qualitative and semiquantitative nailfold videocapillaroscopy assessment in a systemic sclerosis cohort: a two-centre study.

This is the first study to demonstrate reliability of the qualitative and semiquantitative NVC assessment in an SSc cohort between raters at different centres

Nailfold capillaroscopy for day-to-day clinical use: construction of a simple scoring modality as a clinical prognostic index for digital trophic lesions.

Objective Construction of a simple nailfold videocapillaroscopic (NVC) scoring modality as a prognostic index for digital trophic lesions for day-to-day clinical use. Methods An association with a single simple (semi)- quantitatively scored NVC parameter, mean score of capillary loss, was explored in 71 consecutive patients with systemic sclerosis (SSc), and reliable reduction in the number of investigated fi elds (F32\u2013F16\u2013F8\u2013F4). The cut-off value of the prognostic index (mean score of capillary loss calculated over a reduced number of fi elds) for present/future digital trophic lesions was selected by receiver operating curve (ROC) analysis. Results Reduction in the number of fi elds for mean score of capillary loss was reliable from F32 to F8 (intraclass correlation coeffi cient of F16/F32: 0.97; F8/ F32: 0.90). Based on ROC analysis, a prognostic index (mean score of capillary loss as calculated over F8) with a cut-off value of 1.67 is proposed. This value has a sensitivity of 72.22/70.00, specifi city of 70.59/69.77, positive likelihood ratio of 2.46/2.32 and a negative likelihood ratio of 0.39/0.43 for present/future digital trophic lesions. Conclusions A simple prognostic index for digital trophic lesions for daily use in SSc clinics is proposed, limited to the mean score of capillary loss as calculated over eight fi elds (8 fi ngers, 1 fi eld per fi nger)

Do worsening scleroderma capillaroscopic patterns predict future severe organ involvement? a pilot study.

Objective Assessment of associations of nailfold videocapillaroscopy (NVC) scleroderma patterns (\u2018early\u2019, \u2018active\u2019 and \u2018late\u2019) with future severe clinical involvement in a systemic sclerosis (SSc) population. Methods Sixty-six consecutive patients with SSc according to the LeRoy and Medsger criteria underwent NVC assessment at baseline. Videocapillaroscopic images were classifi ed into \u2018normal\u2019, \u2018early\u2019, \u2018active\u2019 or \u2018late\u2019 NVC pattern. Clinical evaluation was performed for nine organ systems (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart and kidney) according to the disease severity scale of Medsger (DSS) at 18\u201324 months of follow-up. Severe clinical involvement was defi ned as category 2\u20134 per organ of the DSS. Results NVC patterns were signifi cantly associated with future severe, peripheral vascular/lung involvement at 18\u201324 months. The OR rose steadily throughout the patterns. The OR for future severe peripheral disease based on simple/multiple (correcting for disease duration, subset and medication) logistic regression was 2.49/2.52 (95% CI 1.33 to 5.43, p=0.003/1.11 to 7.07, p=0.026) for early, 6.18/6.37 for active and 15.35/16.07 for late NVC scleroderma patterns versus the normal NVC pattern. The OR for future severe lung involvement based on simple/multiple regression was 2.54/2.33 (95% CI 1.40 to 5.22, p=0.001/1.13 to 5.52, p=0.021) for early, 6.43/5.44 for active and 16.30/12.68 for late NVC pattern

An Eular Study Group Pilot Study on Reliability of “Simple” Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases : AB1086 

Background: The established EULAR study group on Microcirculation in Rheumatic Diseases (RD) aims to build an international network of centres of excellence to facilitate collaboration and exchange knowledge within Europe. One of its aims is to study natural evolution of microvascular morphology in RD. To this end standardisation of morphological interpretation/nomenclature across diseases is paramount. Objectives: To propose simple capillaroscopic definitions for interpretation of single capillaroscopic morphologies and assess their interobserver reliability. Methods: The simple definitions proposed to assess morphology were: 1) \u201cnormal\u201d: hairpin, tortuous or crossing1; 2) \u201cabnormal\u201d: not hairpin, tortuous or crossing1; 3) \u201cnot evaluable\u201d: whenever rater doubted in classifying between normal and abnormal. Based upon an aimed kappa of 0.80 and equal default prevalences of normal (0.4) and abnormal (0.4) capillary morphology and a smaller proportion of not evaluable (0.2) capillaries, 87 capillaries evaluated by two independent raters were necessary to obtain a half width of the 95% confidence interval (CI) of no larger than 0.2. Consequently, 90 randomly selected single capillaries were presented in 2 batches of 45 single capillaries to 3 groups of raters: experienced independent raters (AH, FI, VR, AS, VS [gold standard]) n=5; attendees to the 6th EULAR course on capillaroscopy, n=34; novices after a 1 hour institutional course at the Ghent University hospital, n=11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. Results: Mean kappa was 0.49 (95% CI: 0.44-0.54) for expert raters, 0.40 (0.36-0.44) for attendees and 0.46 (0.41-0.52) for novices, with overall agreements of 67% (63-71), 63% (60-65) and 67% (63-70) respectively. Comparing only \u201cnormal\u201d vs. \u201cabnormal and not evaluable\u201d capillaries did increase the kappa: 0.51 (0.37-0.65), 0.53 (0.49-0.58), and 0.55 (0.49-0.62). Conclusions: This study shows moderate reliability of \u201csimple\u201d capillaroscopic definitions to describe morphology of individual capillaries by rheumatologists with different expertise on the topic. Further optimization of morphologic interpretation is ongoing. References: Kabasakal Y, et al. Ann Rheum Dis. 1996;55(8):507-12. Cutolo M, Smith V. Nailfold Capillaroscopy. In: Wigley FM et al. editors. Raynaud's phenomenon: A guide to pathogenesis and treatment. New York: Springer Science+Business Media; 2015

Nailfold capillaroscopy for prediction of novel future severe organ involvement in systemic sclerosis.

Objective. Assessment of associations of nailfold videocapillaroscopy (NVC) scleroderma (systemic sclerosis; SSc) ("early," "active," and "late") with novel future severe clinical involvement in 2 independent cohorts. Methods. Sixty-six consecutive Belgian and 82 Italian patients with SSc underwent NYC at baseline. Images were blindly assessed and classified into normal, early, active, or late NYC pattern. Clinical evaluation was performed for 9 organ systems (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart, and kidney) according to the Medsger disease severity scale (DSS) at baseline and in the future (18-24 months of followup). Severe clinical involvement was defined as category 2 to 4 per organ of the DSS. Logistic regression analysis (continuous NYC predictor variable) was performed. Results. The OR to develop novel future severe organ involvement was stronger according to more severe NVC patterns and similar in both cohorts. In simple logistic regression analysis the OR in the Belgian/Italian cohort was 2.16 (95% CI 1.19-4.47, p = 0.010)/2.33 (95% CI 1.36-4.22, p = 0.002) for the early NYC SSc pattern, 4.68/5.42 for the active pattern, and 10.14/12.63 for the late pattern versus the normal pattern. In multiple logistic regression analysis, adjusting for disease duration, subset, and vasoactive medication, the OR was 2.99 (95% CI 1.31-8.82, p = 0.007)/1.88 (95% CI 1.00-3.71, p = 0.050) for the early NYC SSc pattern, 8.93/3.54 for the active pattern, and 26.69/6.66 for the late pattern versus the normal pattern. Conclusion. Capillaroscopy may be predictive of novel future severe organ involvement in SSc, as attested by 2 independent cohorts

Content of non-pharmacological care for systemic sclerosis and educational needs of European health professionals: a EUSHNet survey

Optimising joint reconstruction management in arthritis and bone tumour patient

Nailfold Capillaroscopy for Prediction of Novel Future Severe Organ Involvement in Systemic Sclerosis

Objective. Assessment of associations of nailfold videocapillaroscopy (NVC) scleroderma (systemic sclerosis; SSc) ("early," "active," and "late") with novel future severe clinical involvement in 2 independent cohorts. Methods. Sixty-six consecutive Belgian and 82 Italian patients with SSc underwent NYC at baseline. Images were blindly assessed and classified into normal, early, active, or late NYC pattern. Clinical evaluation was performed for 9 organ systems (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart, and kidney) according to the Medsger disease severity scale (DSS) at baseline and in the future (18-24 months of followup). Severe clinical involvement was defined as category 2 to 4 per organ of the DSS. Logistic regression analysis (continuous NYC predictor variable) was performed. Results. The OR to develop novel future severe organ involvement was stronger according to more severe NVC patterns and similar in both cohorts. In simple logistic regression analysis the OR in the Belgian/Italian cohort was 2.16 (95% CI 1.19-4.47, p = 0.010)/2.33 (95% CI 1.36-4.22, p = 0.002) for the early NYC SSc pattern, 4.68/5.42 for the active pattern, and 10.14/12.63 for the late pattern versus the normal pattern. In multiple logistic regression analysis, adjusting for disease duration, subset, and vasoactive medication, the OR was 2.99 (95% CI 1.31-8.82, p = 0.007)/1.88 (95% CI 1.00-3.71, p = 0.050) for the early NYC SSc pattern, 8.93/3.54 for the active pattern, and 26.69/6.66 for the late pattern versus the normal pattern. Conclusion. Capillaroscopy may be predictive of novel future severe organ involvement in SSc, as attested by 2 independent cohorts