Authors (including presenting author) :
Chu KH, Leung MH, Cheung PY, Chung SCJ, Cheng SYC, Ng CMC, Ho CH
Affiliation :
Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital
Introduction :
Nailfold Capillaroscopy (NFC) is a microscopic examination equivalent of an in vivo assessment of microcirculation. It is an invaluable examination in patients presenting with Raynaud’s phenomenon (RP) (triphasic color changes of fingers commonly on cold exposure) which might underline a spectrum of rheumatic diseases e.g., Scleroderma and mixed connective tissue diseases (CTD).
NFC helps to establish early diagnosis and monitor progression of Scleroderma and CTD. Rheumatologists can allow investigation of other internal organ involvement and starting appropriate drug therapy e.g., immunosuppressants for immune-related part, and vasodilatory therapy as a symptomatic treatment.
Objectives :
To review the clinical data, revised diagnosis and drug changed of nurses performed NFC
Methodology :
NFC was performed by Optilia® Digital Video microscopy with 200x lens with LED illumination. Rheumatologists had performed NFC from 6/2020-11/2022 for existing Scleroderma and mixed CTD patients. Rheumatology nurses started to perform NFC on patients with RP since 11/2022 (study period till 4/2024) after undergoing certified workshop training and having direct supervision from in-house Rheumatologists. 3 Rheumatology nurses had been involved in acquiring video images from NFC and 1 of them, an APN, drafted the reports which would be finally authorized by Rheumatologists.
Result & Outcome :
56 females and 15 males with average 51 years old were performed NFC by Rheumatology nurses. All had abnormal NFC findings. Crucially there were accompanying diagnosis revision and subsequent major medication changes (Rheumatologists’ initiation or stepping-up of immunosuppressants and vasodilatory agents):
Rheumatologists verified all images and agreed on the final conclusions, except 1 (1.5%) reported as non-specifics findings by nurse and edited as late-stage Scleroderma by Rheumatologist.
Rheumatology nurses are competent and reliable in performing NFC and had expanded patients’ group from known Scleroderma and CTD to patients with RP in a wider scope. Waiting time was reasonably around 1 month. The significant clinical impact is apparent with the findings helping the Rheumatologists to revise diagnosis timely and to adjust drug treatment accordingly.
