AB1088 Capillary hemosiderin deposits or extravasations: a subtype of haemorrhagethat acquires separate attention in quantitative analysis of nailfold capillaroscopy in childhood-onset sle
Authors: D. Schonenberg-Meinema, M. van den Berg, A. Nassar-Sheikh-Rashid, M. Boumans, M. Cutolo, T. Kuijpers, V. Smith
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Quality of images in nailfold capillaroscopy has improved in the last years by introduction of videocapillaroscopy. Microangiopathy, as observed in capillaroscopy of SLE-patients,<sup>1–3</sup> can now be described by more detailed quantitative analysis. Recently, in a small cohort (n=22) of childhood-onset SLE (cSLE), we described capillary bleedings by two different subtypes: large haemorrhages and small point-shaped haemorrhages with a total count of resp. 0.2/1.5 per analysed image per patient.<sup>4</sup> These small point shaped haemorrhages have also been described as hemosiderin deposits.<sup>5</sup> <h3>Objectives</h3> To describe the reliability of assessment of two subtypes in capillary haemorrhages by inter-observer agreement. <h3>Methods</h3> Three observers, DS (paediatric rheumatologist with experience in capillaroscopy), AN (fellow paediatric rheumatology without experience in capillaroscopy) and MB (trainee in adult rheumatology with experience in capillaroscopy), scored capillaroscopy images from patients with Raynaud’s phenomenon and with cSLE. The observers were blinded for patient name and diagnosis. The number of haemorrhages were scored per subtype. Hemosiderin deposits were defined as small point-shaped extravasations surrounding the capillary apex (see image). Large haemorrhages were defined according to the Atlas of Capillaroscopy.<sup>6</sup> Reliability was calculated by the intra-class correlation coefficient (ICC) with 95% confidence interval (CI). Statistical analyses was performed by IBM SPSS Statistics version 24. <h3>Results</h3> Two-hundred images from 50 patients (diagnosed with Raynaud’s phenomenon and/or cSLE) were scored by the three independent observers. ICC for the number of capillaries with hemosiderin deposits was 0.77 (95% CI 0.69–0.82). ICC for the number of large capillary haemorrhages was 0.97 (95% CI 0.96–0.98). <h3>Conclusions</h3> Reliability of the observation ‘hemosiderin deposits’ in nailfold videocapillaroscopy was good with an ICC of 0.77. This study shows that capillary haemorrhages can be described in 2 subtypes: ‘large haemorrhages’ and ‘hemosiderin deposits’ which are small point-shaped extravasations surrounding the capillary apex. <h3>References</h3> [1] Ingegnoli F, Herrick AL. Nailfold capillaroscopy in pediatrics. Arthritis Care &amp; Research2013;65(9): 1393–1400. [2] Ingegnoli F, Zeni S, Gerloni V, Fantani F. Capillaroscopic observations in childhood onset rheumatic diseases and healthy controls. Clinical and experimental rheumatology2005;23(6): 905–911. [3] Piotto DGP, Len CA, Hilario MOE, Terreri MTRA. Nailfold capillaroscopy in children and adolescents with rheumatic diseases. Rev Bras Reumatol2012;52(5):722–732. [4] Schonenberg-Meinema D, van den Berg JM, Nassar-Sheikh-Rashid A, de Bree GJ, Hak AE, van Onna M, Melsen K, Cutolo M, Kuijpers TW, Smith V. Capillaroscopy findings in childhood-onset systemic lupus erythematosus, a Dutch experience of 20 children and adolescents. EULAR2017, poster 4704. [5] Meroni M, Pizzorni C, Sulli A, Rossi P, Stobbione P, Cutolo M. Selected nailfold videocapillaroscopy changes are linked to SLE-onet in a cohort of UCTD subjects. ACR2017, poster 698. [6] Cutolo M. Atlas of capillaroscopy in rheumatic diseases. Milan: Elsevier;2010. <h3>Disclosure of Interest</h3> None declared