The 2020 Pediatric Rheumatology Symposium, originally scheduled for April 29 – May 2, was postponed due to COVID-19; therefore, abstracts were not presented as scheduled.
Session Type: ACR Abstract Session
Session Time: 5:00PM-6:00PM
Background/Purpose: In previous studies, micro-haemorrhages have often been observed in nailfold capillaroscopy in SLE.1 The interpretation of this finding is still a topic of research. Recently, a new subtype of capillary micro-haemorrhage was described in 82.9% (n=34/41) of a childhood-onset Systemic Lupus Erythematosus (cSLE) cohort (manuscript in preparation). The aim of this current study was to evaluate the inter- and intra-observer reliability qualitatively and quantitatively for different subtypes of micro-haemorrhages, as identified by nailfold videocapillaroscopy (NVC) in cSLE patients.
1 Cutolo M, Melsens K, Wijnant S, Ingegnoli F, Thevissen K, De Keyser F, et al. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev. 2018;17(4):344-52.
Methods: Five raters from different centres blindly evaluated 140 NVC images from 35 cSLE-patients, diagnosed according to the Systemic Lupus International Collaborating Clinics (SLICC) criteria. The raters assessed the anonymized NVC images qualitatively (present or absent) and quantitatively (total number) on three different subtypes of microhaemorrhages: 1) punctate extravasations; point-shaped, localized around or in the apical centre of capillary loop. 2) perivascular haemorrhage; as 1) but in grouped/confluent aspect. 3) large confluent haemorrhage, migrating in line with the capillary to distal towards the cuticle.
For the qualitative assessment of the haemorrhages, Fleiss’ and Cohen’s kappa analyses were used. For quantitative data-analysis, the intraclass correlation coefficient (ICC) was used. As punctate extravasations and perivascular haemorrhages were sometimes difficult to distinguish, a merged (mean) Kappa/ICC was also calculated as one sub-group.
Results: Qualitative assessment of the different subtypes of micro-haemorrhages showed a kappa value of 0.65 (95% CI: 0.60-0.70) for punctate extravasations and perivascular haemorrhages merged and a kappa value of 0.78 (95% CI: 0.72-0.83) for large confluent haemorrhages. For the quantitative scoring, ICC was 0.82 (95% CI: 0.76-0.87) for the merged group and ICC 0.93 (95% CI: 0.91-0.95) for large confluent haemorrhages.
Conclusion: This is the first study to investigate intra- and inter-observer reliability for different subtypes of nailfold capillary micro-haemorrhages in cSLE. A good inter-observer agreement was shown for the combined subgroups of punctate extravasations and perivascular haemorrhages versus an almost perfect agreement in large confluent haemorrhages. Our findings show that different subgroups of capillary micro-haemorrhages are reproducible. Future studies should elucidate whether the different subtypes of capillary microhaemorrhages are specific for (c)SLE and, if so, whether these micro-haemorrhages reflect (endothelial) pathophysiology in SLE, and could be of diagnostic use.
To cite this abstract in AMA style:Bergkamp S, Schonenberg-Meinema D, van den Berg M, Smith V, Vanhaecke A, Melsens K, Nassar Sheikh Rashid A, Kuijpers T, Boumans M. A Good Inter- and Intra-observer Reliability of Subtypes in Nailfold Capillary Micro-haemorrhages in Childhood-onset Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 4). https://acrabstracts.org/abstract/a-good-inter-and-intra-observer-reliability-of-subtypes-in-nailfold-capillary-micro-haemorrhages-in-childhood-onset-systemic-lupus-erythematosus/. Accessed August 4, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-good-inter-and-intra-observer-reliability-of-subtypes-in-nailfold-capillary-micro-haemorrhages-in-childhood-onset-systemic-lupus-erythematosus/