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Nailfold capillaroscopy: a survey of current UK practice and ‘next steps’ to increase uptake amongst rheumatologists

Rheumatology (Oxford). 2022 May 28:keac320. doi: 10.1093/rheumatology/keac320. Online ahead of print.

ABSTRACT

OBJECTIVES: To identify barriers to the use of nailfold capillaroscopy as a diagnostic tool for patients presenting with Raynaud’s phenomenon in UK rheumatology centres, and to obtain rheumatologists’ views on a proposed internet-based standardised system for clinical reporting of nailfold capillaroscopy images.

METHODS: An online survey was developed using expert opinion from clinicians, scientists and health service researchers. The survey was piloted and sent to UK-based rheumatologists using established electronic mailing lists between October 2020 and March 2021. Survey data were analysed using descriptive statistics.

RESULTS: 104 rheumatologists representing rheumatology centres across the UK responded to the survey. Wide variations in terms of workloads and practices were described. 34 (33%) respondents reported using nailfold capillaroscopy only at their own centre, 33 (32%) referred to other centres, 9 (9%) did both and 28 (27%) did not use capillaroscopy at all. Of the 43 respondents using capillaroscopy on site, 25 (58%) used either a dermatoscope or USB microscope, and 9 (21%) used videocapillaroscopy. Amongst the 61 respondents not undertaking capillaroscopy on site, barriers included lack of equipment (85%), lack of experience in acquiring images (69%) and lack of expertise in interpreting images (67%). Sixty-six respondents (63%) expressed interest in an internet-based, standardised automated system for reporting images.

CONCLUSION: Most UK rheumatologists currently do not perform nailfold capillaroscopy on site. An internet-based nailfold capillaroscopy system, for use with low cost microscopes as well as with videocapillaroscopy, could help increase uptake of capillaroscopy and thereby facilitate early diagnosis of systemic sclerosis across the UK.

PMID:35640131 | DOI:10.1093/rheumatology/keac320

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