Journal Article

An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases

Vanessa Smith, Sam Beeckman, Ariane L. Herrick, Saskia Decuman, Ellen Deschepper, Filip De Keyser, Oliver Distler, Ivan Foeldvari, Francesca Ingegnoli, Ulf Müller-Ladner, Valeria Riccieri, Gabriela Riemekasten, Alberto Sulli, Alexandre Voskuyl and Maurizio Cutolo

in Rheumatology

Volume 55, issue 5, pages 883-890
Published in print May 2016 | ISSN: 1462-0324
Published online February 2016 | e-ISSN: 1462-0332 | DOI: http://dx.doi.org/10.1093/rheumatology/kev441
An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases

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Objective. To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability.

Methods. The simple definitions proposed were: normal—hairpin, tortuous or crossing; abnormal—not hairpin, not tortuous and not crossing; not evaluable—whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients.

Results. Mean kappa based on 90 capillaries was 0.47 (95% CI: 0.39, 0.54) for expert raters, 0.40 (95% CI: 0.36, 0.44) for attendees and 0.46 (95% CI: 0.41, 0.52) for novices, with overall agreements of 67% (95% CI: 63, 71), 63% (95% CI: 60, 65) and 67% (95% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95% CI: 0.37, 0.65), 0.53 (95% CI: 0.49, 0.58) and 0.55 (95% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95% CI: 0.74, 0.89) for novices (n = 44).

Conclusion. This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.

Keywords: EULAR study group on microcirculation; capillaroscopy; morphology; reliability; novices; trainees; experts; definitions

Journal Article.  3701 words.  Illustrated.

Subjects: Radiology

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