An EULAR Study Group Pilot Study on Reliability of Simple� Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases

Vanessa Smith¹, Sam Beeckman², Ariane L. Herrick³, Saskia Decuman⁴, Ellen Deschepper⁵, Filip De Keyser⁶, Oliver Distler⁷, Ivan Foeldvari⁸, Francesca Ingegnoli⁹, Ulf Müller-Ladner¹⁰, Valeria Riccieri¹¹, Gabriela Riemekasten¹², Alberto Sulli¹³, Alexandre E. Voskuyl¹⁴ and Maurizio Cutolo¹³, ¹Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium, ²Department of Rheumatology, Ghent University, Ghent University Hospital,, Ghent, Belgium, ³Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom, ⁴Department of Rheumatology, UGent, Ghent, Belgium, ⁵Biostatistics Unit, Biostatistics Unit, Ghent University, Ghent, Belgium, ⁶Rheumatology, Ghent University Hospital, Ghent, Belgium, ⁷Research of Systemic Autoimmune Diseases, Division of Rheumatology, University Hospital Zurich, 8952 Schlieren, Switzerland, ⁸Hamburger Zentrum für Kinder-und Jugendrheumatologie, Hamburg, Germany, ⁹Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Milano, Italy, ¹⁰Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany, ¹¹Cattedra di Reumatologia, Dip Clinica e Terapia Medica, Sapienza Università di Roma, Roma, Italy, ¹²Clinic of Rheumatology, University of Luebeck, Lübeck, Germany, ¹³Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS A.O.U. San Martino-IST, University of Genova, Genoa, Italy, Genoa, Italy, ¹⁴Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University medical center, Amsterdam, Netherlands

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: capillaroscopy and systemic sclerosis

Session Information

Date: Tuesday, November 10, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The 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 across diseases is paramount. Hence,
the objective is to propose simple capillaroscopic definitions for interpretation
of single capillaroscopic morphologies and assess their interrater reliability. Methods: The simple definitions to assess morphology were: 1) “normal”: hairpin,
tortuous or crossing; 2) “abnormal”: not hairpin, tortuous or crossing; 3) “not
evaluable”: whenever rater doubted in classifying between normal and abnormal
(figure 1). Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4)
and not evaluable (0.2) capillaries, 87 capillaries evaluated by two raters
were necessary to obtain a half width of the 95% confidence interval (CI) of no
larger than 0.2. Consequently, 90 single capillaries were presented to 3
groups of raters: experienced independent raters, n = 5; attendees to the 6th
EULAR course on capillaroscopy, n = 34; novices after a 1 hour course, n = 11.
Interrater agreement was assessed by calculation of proportion of agreement and
by kappa coefficients. Results: Mean kappa was 0.47 (95% CI: 0.39-0.54) 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 “normal” vs. “abnormal and not evaluable” capillaries did increase the
kappa: 0.51 (0.37-0.65), 0.53 (0.49-0.58), and 0.55 (0.49-0.62). On the
condition that the capillaries were classifiable, the mean kappa was 0.62
(0.50-0.74) for expert raters (n = 65), 0.76 (0.69-0.83) for attendees (n = 20)
and 0.81 (0.74-0.89) for novices (n = 44). Conclusion: This study shows moderate reliability of “simple” capillaroscopic
definitions to describe morphology of individual capillaries by rheumatologists
with different expertise on the topic. Novices are capable to distinguish
normal from abnormal capillaries by means of a 1-hour training session. Consequently,
when encountering an abnormal capillary, they may refer the patient to an
expert in nailfold videocapillaroscopy.

Figure 1: Information given to the raters concerning the definitions
of normal and abnormal capillaries

Disclosure: V. Smith, None; S. Beeckman, None; A. L. Herrick, None; S. Decuman, None; E. Deschepper, None; F. De Keyser, None; O. Distler, None; I. Foeldvari, None; F. Ingegnoli, None; U. Müller-Ladner, None; V. Riccieri, None; G. Riemekasten, None; A. Sulli, None; A. E. Voskuyl, None; M. Cutolo, None.

To cite this abstract in AMA style:

Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, Distler O, Foeldvari I, Ingegnoli F, Müller-Ladner U, Riccieri V, Riemekasten G, Sulli A, Voskuyl AE, Cutolo M. An EULAR Study Group Pilot Study on Reliability of Simple� Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/an-eular-study-group-pilot-study-on-reliability-of-simple%ef%bf%bd-capillaroscopic-definitions-to-describe-capillary-morphology-in-rheumatic-diseases/. Accessed .

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