Authors (including presenting author) :
Cheung YS (1), Chay TW (1), Lai TL (1), Au CK (1), Yeo SH (1)
Affiliation :
(1) Rheumatology Unit, Department of Medicine, Tseung Kwan O Hospital
Introduction :
Nailfold capillaroscopy is a valuable tool in rheumatological practice. Its utility in differentiating between primary and secondary Raynaud’s phenomenon is well established, allowing timely identification of possible underlying autoimmune disorders. Its role in systemic sclerosis (SS) is also indispensable. Not only does it help in diagnosing and staging SS, it also helps to predict disease activity, complications, and organ involvement. Moreover, it has been shown to be informative on treatment response after immunosuppressants. More evidence has recently emerged regarding the use of nailfold capillaroscopy in other autoimmune diseases, such as diagnosing mixed connective tissue disease (MCTD), predicting disease activity in systemic lupus erythematosus, differentiating between dermatomyositis and polymyositis, identifying possible underlying connective tissue disease in patients with interstitial lung diseases, etc.
Objectives :
1. Facilitate diagnosis
2. Staging of disease
3. Monitor disease activity and progression
Methodology :
The Rheumatology unit in Tseung Kwan O Hospital has commenced capillaroscopy service for rheumatological patients since April 2023.
Nailfold capillaroscopy was performed by rheumatology nurses (RhN), who prepared reports detailing capillary density, dimensions, abnormal morphology, and microhemorrhages. Rheumatologists reviewed the reports, provided a diagnosis, and discussed results with patients during same-day follow-ups. Based on the findings, drug titration and follow-up plans were arranged.
Result & Outcome :
From August 2023 to December 2024, 45 patients recruited from the rheumatology clinic underwent capillaroscopy, with a male-to-female ratio of 4:41. The primary reasons for referral were differentiation of diagnoses and SS staging. 26 (57.8%) referrals were for Raynaud's phenomenon, 8 (17.8%) for scleroderma, and 11 (24.4%) for other conditions, including positive autoantibodies, MCTD, and dermatomyositis.
Capillaroscopy findings led to drug adjustments in 15 cases. 14 patients required initiation or escalation of anti-rheumatic drugs, while one patient’s medication was tapered as rheumatological diseases were excluded. 15 patients continued current treatment, 6 required further capillaroscopy monitoring, and 9 cases were planned to be discharged from the rheumatology clinic.
The capillaroscopy service has effectively enabled early and accurate diagnosis, staging, and monitoring of rheumatological diseases. It also provides valuable information for medication adjustment and follow-up plans.
The involvement of RhN in performing examinations and preparing preliminary reports enhances workflow efficiency, facilitating timely and effective management of such conditions.
