AB1180 CLINICAL UTILITY OF NAILFOLD CAPILLAROSCOPY: DESCRIPTION OF A REAL-LIFE COHORT
Authors: A. Mocritcaia, S. Farietta Varela, B. Frade-Sosa, J. Sarmiento-Monroy, A. Azuaga, V. Ruiz, A. Zacarias Crovato, H. Florez, A. Ponce, J. Ramírez, R. Sanmarti, J. A. Gómez-Puerta, P. Corzo
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Nailfold capillaroscopy (NFC) is a simple, in-vivo, non-invasive, reliable, and inexpensive tool to analyze microvascular abnormalities in autoimmune rheumatic diseases. It proves valuable in distinguishing primary and secondary Raynaud phenomenon (RF) and contributes to the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc)<sup>1</sup>, being characterized by diagnostic and prognostic significance. Moreover, capillaroscopic changes have been observed in systemic lupus erythematosus (SLE), anti-phospholipid syndrome (APS), and Sjogren's syndrome (SSj). Despite its potential benefits in Rheumatology clinical practice, barriers, such as limited access to equipment and lack of experience in acquiring and interpreting images, hinder its widespread use. <h3>Objectives:</h3> We evaluated the diagnostic utility of NFC in a tertiary hospital, two years post-implementation, with a prospective assessment after at least six months. Our aim is to underscore the importance of its systematic use, given its diagnostic and therapeutic implications. <h3>Methods:</h3> A prospective study of all patients undergoing NFC in the last two years was conducted. Clinical data (age, sex, indication of NFC, its results, and suspected or previous diagnosis), laboratory findings (such as clinically relevant antibodies), the impact of NFC on further tests, diagnostic or therapeutic changes, and the need for Rheumatologist follow-up were assessed within at least a six-month period. <h3>Results:</h3> Over 2 years, 179 NFC were performed. Of these, 109 (60.9%) were as initial study of RF, 60 (33.5%) as a complementary study to diagnosed diseases, and 10 (5.6%) for other manifestations (such as perniosis, psoriasis, acrocyanosis, and Achenbach syndrome). Out of the 60 patients who had already been diagnosed with another disease, 12 (6.7%) suffered from undifferentiated tissue connective disease, 10 (5.6%) from SSc, 8 (4.5%) from rheumatoid arthritis, 6 (3.4%) from mixed tissue connective disease, 5 (2.8%) from SSj, 4 (2.2%) from spondylarthritis, 3 (1.7%) from SLE, and 12 (6.7) from other minor conditions. 96 NFC (53.6%) resulted normal, while 83 (46.4%) presented altered results, being 55 characterized by non-scleroderma pattern and 28 by scleroderma pattern (16 early, 8 active, and 4 late), following EULAR Study Group on Microcirculation in Rheumatic Diseases standardization<sup>1</sup>. Undergoing NFC led to diagnostic change in 32 patients (17.9%) (see Figure 1), to any therapeutic change in 15 (8.4%) and 39 patients (21.8%) benefited from an ampliation of supplementary tests, such as lung function tests (46.2%), autoimmunity laboratory tests (38.5%), thorax CT (33.3%), echocardiography (30.8%), articular ultrasound (7.7%), sicca syndrome study (7.7%), and others (such as PET/CT, CT angiography, autoinflammatory disease genetic tests, and cryoglobulins levels; 12.8%). Additionally, after performing NFC, 66 patients (36.9%) did not need additional follow-up and were discharged, while 113 (63.1%) maintained regular control. See overview of study results in Figure 2. <h3>Conclusion:</h3> In our cohort, NFC led to diagnostic changes in 17.9% and therapeutic changes in 8.4% of patients. Notably, 36.9% of patients were discharged after NFC, while 63.1% required follow-up. NFC prompted additional tests in 39 patients (21.8%), including lung function tests (36.2%) and autoimmunity tests (38.5%). NFC is a valuable technique deserving broader implementation in Rheumatology departments. Its capability to alter patient diagnoses, leading to therapeutic changes, emphasizes its clinical significance. <h3>REFERENCES:</h3> [1] Smith V, Herrick AL, Ingegnoli F, Damjanov N, De Angelis R, Denton CP et al; EULAR Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium Group on Capillaroscopy. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev. 2020 Mar;19(3):102458. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>