SP0132 METHODS AND TOOLS FOR QUANTIZATION OF CAPILLAROSCOPIC MORPHOLOGICAL CHANGES
Authors: Francesca Ingegnoli
Journal: Annals of the Rheumatic Diseases (2019)

<h3></h3> Nailfold capillaroscopy is the one most used technique in both clinical and research settings by adult physicians and paediatric rheumatologists to assess patients with Raynaud"s phenomenon as shown by an international survey on non-invasive techniques to assess the microcirculation performed under the aegis of members of the EULAR Study Group on Microcirculation in Rheumatic diseases [1]. Nailfold capillaroscopy is a simple non-invasive imaging technique mainly used to observe capillaries on the skin surface. After application of a drop of immersion oil, capillaries can be observed with a magnification lens because they run parallel to the epidermis at the nailbed area [2]. A number of different instruments can be used to perform the exam. They have different characteristics in terms of their cost, quality of images, magnifications, training period, portability, software for image analysis and storage. Some of these instruments can be used both in clinical and research settings such as the stereomicroscope and the videocapillaroscope. The stereomicroscope allows the widefield visualization of the nailfold with low magnifications, the training is relatively short, but the examination is difficult to perform in patients with digital flexion contractures. There appears to be consensus regarding the use of videocapillaroscopy that allows a detailed visualization of capillary morphology using higher magnifications (100-300x). Contact probe with polarized light microscopy permits easier observation of the skin surface, and the training period is briefer. Specific software are available for images analysis, storage, and complete medical reports (text + images) can be produced. By contrast, in a clinical setting, nailfold capillaries can generally be visualized using more simple, but also efficient tools such as a dermatoscope, USB microscope, ophtamloscope or smartphone device. The quality of images can be quite good, although the lower magnification means that some details are unlikely to be seen, and they often lack the possibility of image storage and measurement. In particular, the dermatoscope with magnification of the order of x10 is a small, inexpensive and easily portable piece of equipment that has been suggested to be comparable to videocapillaroscopy in routine clinical practice. As the study of capillary morphology provides clinically relevant information in the management of patients with scleroderma-spectrum diseases, the development of specific software to standardize and automatize the analysis is ongoing [3-4]. <h3>References:</h3> [1] Ingegnoli F, Smith V, Sulli A, Cutolo M. Capillaroscopy in Routine Diagnostics: Potentials and Limitations. Curr Rheumatol Rev. 2018 20;14(1):5-11 [2] Ingegnoli F, Ughi N, Dinsdale G, Orenti A, Boracchi P, Allanore Y, et al.; EULAR Study Group on Microcirculation in RheumaticDiseases. An international SUrvey on non-iNvaSive tecHniques to assess the mIcrocirculation in patients with RayNaud"s phEnomenon (SUNSHINE survey). Rheumatol Int. 2017;37(11):1879-1890. [3] Cutolo M, Trombetta AC, Melsens K, Pizzorni C, Sulli A, Ruaro B, et al. Automated assessment of absolute nailfold capillary number on videocapillaroscopic images: Proof of principle and validation in systemic sclerosis. Microcirculation. 2018;25(4):e12447. [4] Berks M, Dinsdale G, Murray A, Moore T, Manning J, Taylor C, Herrick AL. Automated structure and flow measurement - a promising tool in nailfold capillaroscopy. Microvasc Res. 2018;118:173-177. <h3>Disclosure of Interests:</h3> None declared