E062 Nailfold capillaroscopy: its application in routine clinical practice

Abstract

Abstract Background/Aims Nailfold capillaroscopy (NFC) is a non-invasive tool to evaluate the structural microvascular abnormalities found in systemic sclerosis (SSc). NFC allows for the visualization of the capillary bed at the nailfold, providing valuable insights into the structure and function of these capillaries. NFC helps differentiate primary from secondary Raynaud’s phenomenon (RP). Abnormal NFC is included in the 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria and due to its predictive value of developing SSc is included in the Very Early Diagnosis of SSc (VEDOSS) criteria. Dudley Group NHS FT runs a consultant-led service supported by a specialty trainee where clinical review is carried out alongside NFC using video capillaroscopy. Patients can be referred to this clinic from rheumatology or respiratory colleagues. Methods We audited all patients who had attended a monthly NFC clinic between September 2021 and October 2023. We reviewed clinical letters and electronic patient record system and collected details of: demographics; immunology; clinical characteristics; reason for attending the clinic; NFC findings; and diagnosis. NFC findings were classified as normal or abnormal (to include scleroderma pattern and non-specific changes). Data was analysed using excel for individual variables and their comparison with nailfold capillaroscopy results. Results We identified 80 patients, of which 63 (79%) were females and median age was 54.5 years. ANA was positive in 64 (80%) patients, SSc and myositis immunology blots were positive in 41 (51%) and 4 (5%) respectively. Clinical characteristics included RP in 71 (89%) and interstitial lung disease (ILD) in 17 (21%). The reasons for attending the NFC clinic were categorised as: to exclude secondary causes of RP (52; 65%); to aid diagnosis of suspected SSc (23; 29%); surveillance of known SSc (5; 6%). NFC was normal in 42 patients. In the 38 patients where NFC was abnormal the clinical diagnosis was categorised as: primary RP (8; 10%); SSc spectrum of disease (17; 21%); and another CTD (20; 25%). Of patients with SSc spectrum of disease: 24% (4/17) had a diagnosis of VEDoSS; 47% (8/17) Limited Cutaneous SSc; and 29% (5/17) Diffuse SSc. The presence of RP and ANA was not significantly different in patients with abnormal NFC. There was a non-significant association between the presence of ILD and abnormal NFC. 9/17 (52%) patients with ILD had an abnormal NFC compared to 18/63 (29%) patients without ILD (p = 0.059). Conclusion NFC is a simple procedure in conjunction with a clinical review to enhance the early diagnosis of SSc and exclusion of secondary Raynaud’s. It supports education and training as a tool for learning as being part of the curriculum. Disclosure S.A. Tabassum: None. K.M.J. Douglas: None. E. Udeshika: None.