Background/Purpose:  Nailfold videocapillaroscopy (VCP) has become an established method to assess the microcirculation in patients with Raynaud’s phenomenon and connective tissue diseases. The 2013 Systemic Sclerosis (SSc) criteria included capillaroscopy as a necessary tool for SSc classification. Adequate training for identification of Systemic Sclerosis capillaroscopic patterns is relevant for all Rheumatologists. To date, there is little evidence of the reliability of VCP findings amongst different readers. We evaluated inter- and intra-reader agreement of 13 Rheumatologists to identify SSc capillaroscopy patterns (“early”, “active” and “late”) proposed by Cutolo et al (ref 1).

Methods:  Thirteen rheumatologists (7 without experience and 6 with more than 2 years of experience in the routine performance and reading of capillaroscopic images) received a 20 min training regarding the identification of SSc capillarosocpy patterns to standardize reading criteria. Then, they individually rated 60 videocapillaroscopy images (12 from healthy subjects, 48 from SSc patients) at baseline, and 4 weeks after the first reading using an electronic platform in order to perform the intra-reader exercise. The reading of an expert with more than 15 years of experience in capillaroscopy was considered the gold standard. Data was analyzed using Cohen´s kappa for concordance, Student´s t test and ANOVA were used to compare kappa means for inter-reader, intra-reader and inter-pattern readings.

Results:  Mean inter-reader and intra-reader kappa were 0.45 and 0.49, respectively, reflecting moderate agreement. Mean kappa scores were significantly higher among experienced readers when compared with unexperienced readers (inter-reader kappa: 0.58 vs 0.34, p=0.001, intra-reader kappa: 0.65 vs 0.37, p=0.01). Agreement was substantial (kappa =0.61) for the identification of normal vs abnormal capillaroscopy, and higher than the overall agreement (p=0.009). Agreement was higher for the identification of “active” (0.48, p=0.009) and “late” SSc patterns (0.56, p=0.008) than for the identification of “early” SSc pattern (0.35, p=0.003) when compared to overall agreement in all participants. Agreement for “early” and “active” patterns was higher in experienced vs not experienced readers (“early” pattern kappa=0.45 vs 0.26, p=0.01, “active” pattern kappa= 0.62 vs 0.35, p=0.006, “late” pattern kappa=0.66 vs 0.48, p=0.12).

Conclusion:  There is moderate agreement among rheumatologists for the identification of SSc videocapillaroscopy patterns, while there is substantial agreement among rheumatologists regardless their experience in videocapillaroscopy, in the identification of normal and abnormal capillaroscopic images. Agreement for the identification of “active” and “late” patterns is higher than for “early” capillaroscopic pattern. The identification of “early” capillaroscopic changes may require more experience in the performance and interpretation of this technique. Ref 1. Cutolo M et al. J Rheumatol 2000;27:155-60.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/can-nailfold-videocapillaroscopy-images-be-interpreted-reliably-by-different-observers-results-of-an-inter-reader-and-intra-reader-exercise-among-rheumatologists-with-different-experience-in-this-fie/