title: Office capillaroscopy in systemic sclerosis.
abstract: The aims of this study are to assess the reliability of two office techniques, the ophthalmoscope and the Dermlite dermatoscope, and to detect nailfold capillaroscopy abnormalities in systemic sclerosis (SSc). Two separate studies were performed. In the first, the nailfolds of two fingers on one hand of 13 SSc patients and two normals were examined by four rheumatologists using an ophthalmoscope. In the second, the nailfolds of the two fingers of each hand of six SSc patients and two normals were examined by six rheumatologists with a Dermlite dermatoscope. Widefield capillary microscopy was performed by one observer in the ophthalmoscope study to assess validity. The examiners determined the presence or absence of dilated loops, giant capillary loops, and/or avascular areas on each digit. The kappa coefficient was calculated to demonstrate agreement. With the ophtalmoscope, the inter-observer kappa coefficients were 0.43, 0.54, and 0.19; the average intra-observer agreements were 0.61, 0.56, and 0.31; and the ophthalmoscope-microscope agreement were 0.63, 0.52, and <0.1 for dilated capillaries, giant capillaries, and avascular areas, respectively. With the dermatoscope, the kappa values for inter-observer reliability were 0.63, 0.40, and 0.20; and intra-observer reliability was 0.71, 0.55, and 0.40 for dilated capillaries, giant capillaries, and avascular areas, respectively. The ophthalmoscope and the dermatoscope provide moderate to substantial reliability to detect the presence of giant and dilated capillaries but poor inter-observer agreement for avascular areas. The ophthalmoscope is valid when compared to the microscope for detecting giant or dilated capillaries. We conclude that these techniques are useful office tools to detect capillary abnormalities in SSc.
authors.affiliation: McGill University, and Jewish General Hospital, Montreal, Quebec, Canada. mbaron@rhu.jgh.mcgill.ca
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.forename: Mary
authors.initials: M
authors.lastname: Bell
authors.forename: Arthur
authors.initials: A
authors.lastname: Bookman
authors.forename: Maura
authors.initials: M
authors.lastname: Buchignani
authors.forename: James
authors.initials: J
authors.lastname: Dunne
authors.forename: Marie
authors.initials: M
authors.lastname: Hudson
authors.forename: Dana
authors.initials: D
authors.lastname: Jerome
authors.forename: Sindhu R
authors.initials: SR
authors.lastname: Johnson
authors.forename: Niall
authors.initials: N
authors.lastname: Jones
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Kaminska
authors.forename: Terri
authors.initials: T
authors.lastname: Lupton
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Mathieu
authors.forename: Janet
authors.initials: J
authors.lastname: Pope
authors.forename: Russell
authors.initials: R
authors.lastname: Steele
authors.forename: Suzanne
authors.initials: S
authors.lastname: Taillefer
mesh_terms: D046169:Dermoscopy / Q000379:methods*; D006801:Humans; D020678:Microscopic Angioscopy / Q000379:methods*; D008875:Middle Aged; D009262:Nails / Q000098:blood supply; D015588:Observer Variation; D009887:Ophthalmoscopy / Q000379:methods*; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000150:complications* / Q000473:pathology; D012680:Sensitivity and Specificity