SAT0296 FAST TRACK ALGORITHM: HOW TO DIFFERENTIATE A SCLERODERMA PATTERN FROM A NON-SCLERODERMA PATTERN
Authors: Vanessa Smith, Amber Vanhaecke, Miguel Guerra, Rossella De Angelis, Ellen Deschepper, Christopher Denton, Oliver Distler, Ivan Foeldvari, Eric Hachulla, Francesca Ingegnoli, Ulf Müller-Ladner, Yves Piette, Valeria Riccieri, Barbara Ruaro, Alberto Sulli, Jacob M. van Laar, Ariane Herrick, Maurizio Cutolo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The European League Against Rheumatism Study Group on Microcirculation in Rheumatic Diseases is a non-profit international network of expert centres. Its main research focus is to investigate the morphology and function of the microcirculation with different non-invasive techniques such as nailfold videocapillaroscopy (NVC). NVC is of paramount importance for the differential diagnosis of primary and secondary Raynaud's phenomenon [1], and is part of the 2013 ACR/EULAR classification criteria for systemic sclerosis. As there is a wide variety of non-scleroderma patterns, the categorisation of capillaroscopic images as non-scleroderma patterns may be a challenge to the capillaroscopist. <h3>Objectives:</h3> This study was designed to propose a simple fast track algorithm to differentiate scleroderma patterns from non-scleroderma patterns and to assess its interobserver reliability. <h3>Methods:</h3> During the 8<sup>th</sup> EULAR course on capillaroscopy held in Genoa, September 2018, a lecture on teaching the fast tract algorithm to categorise an image as non-scleroderma (category 1) or scleroderma pattern (category 2) (see figure) was given to all attendees (from 43 different countries): 6 experts, 68 novices, 53 moderately experienced (&lt; 5 years of experience with capillaroscopy) and 14 experienced physicians (&gt; 5 years of experience with capillaroscopy). Immediately after training, an examination was performed on 30 images. Classification of the images was defined by the presenter (VS) as the gold standard. Interobserver reliability was assessed by the calculation of kappa coefficients and proportion of agreement versus the gold standard. <h3>Results:</h3> The light kappa was 1 for the independent experts (n=6) and 0.92 for the attendees (n=135). When comparing with the gold standard, an equal mean kappa of 0.96 (95%CI 0.95 – 0.98) was found for both independent experts and attendees. Analyses according to the reported level of experience on capillaroscopy revealed a mean index of reliability of 0.98 (95%CI 0.96 – 0.99) for novices, 0.96 (95%CI 0.93 – 0.99) for moderately experienced raters and 0.93 (95%CI 0.85 – 1.01) for experienced raters. <h3>Conclusion:</h3> For the first time a fast track algorithm has been developed that was trainable within an hour to non-experienced capillaroscopists and has an excellent reliability to discern a non-scleroderma from a scleroderma pattern by medical doctors with varying levels of expertise in capillaroscopy. <h3>Reference</h3> [1] Koenig M, et al. Arthritis Rheum. 2008;58(12):3902-12. <h3>Disclosure of Interests:</h3> Vanessa Smith: None declared, Amber Vanhaecke: None declared, Miguel Guerra: None declared, Rossella De Angelis: None declared, Ellen Deschepper: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, Inventiva, CSF Behring, Consultant for: Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Bayer, Oliver Distler Grant/research support from: Prof. Distler received research funding from Actelion, Bayer, Boehringer Ingelheim and Mitsubishi Tanabe to investigate potential treatments of scleroderma and its complications, Consultant for: Prof. Distler has/had consultancy relationship within the last 3 years with Actelion, AnaMar, Bayer, Boehringer Ingelheim, ChemomAb, espeRare foundation, Genentech/Roche, GSK, Inventiva, Italfarmaco, iQvia, Lilly, medac, MedImmune, Mitsubishi Tanabe Pharma, Pharmacyclics, Novartis, Pfizer, Sanofi, Serodapharm and UCB in the area of potential treatments of scleroderma and its complications. In addition, he had/has consultancy relationship within the last 3 years with A. Menarini, Amgen, Abbvie, GSK, Mepha, MSD, Pfizer and UCB in the field of arthritides and related disorders, Ivan Foeldvari Consultant for: Chugai, Novartis, Eric Hachulla Consultant for: Received consulting fees or other remuneration from Actelion, GSK, Pfizer, and Bayer, Francesca Ingegnoli: None declared, Ulf Müller-Ladner Grant/research support from: Projekt supported by an unrestricted educational grant from Celgene GmbH., Yves Piette: None declared, Valeria Riccieri: None declared, Barbara Ruaro: None declared, Alberto Sulli: None declared, Jacob M. van Laar Grant/research support from: Genentech, Consultant for: F. Hoffmann-La Roche, Ariane Herrick: None declared, Maurizio Cutolo: None declared