{
  "abstract": "Introduction Systemic Sclerosis (SSc) is an autoimmune disease causing small-vessel vasculopathy, inflammation and fibrosis of the skin and internal organs. The Very Early Diagnosis of Systemic Sclerosis (VEDOSS) criteria aim to detect patients in the preclinical stage of SSc using features such as Raynaud’s phenomenon, disease-specific autoantibodies, and nailfold videocapillaroscopy (NVC) findings. NVC plays an important diagnostic role in early SSc, yet it is time-consuming, requiring evaluation of eight fingers. Previous studies emphasized that examining fewer fingers reduces diagnostic sensitivity in patients with established SSc, but limited data exist in patients with very early SSc. This study investigates whether NVC assessment of fewer fingers offers sufficient diagnostic accuracy to detect a scleroderma pattern in patients suspected of very early SSc.Material and Methods This retrospective cross-sectional diagnostic test accuracy study analyzed data from 76 patients screened for the HHE-trial, which enrolled individuals fulfilling the adjusted VEDOSS criteria, including the presence of puffy fingers for < 3 years. All patients underwent NVC imaging of eight fingers and capillary characteristics were scored according to standardized EULAR definitions. The most severe pattern per patient determined the reference (eight-finger) outcome. Agreement between each individual finger and the reference was assessed using Cohen’s kappa values. Combinations of two and four fingers -based on fingers with the highest individual agreement- were also analyzed. The primary outcome was the presence of a scleroderma pattern.Results NVC of a single finger showed insufficient agreement with the eight-finger reference, with Cohen’s kappa values indicating weak consistency (K= 0.23 – 0.47). However, a two-finger combination of digit IV of both hands, improved agreement moderately (K=0.63), and a four-finger combination of digits III and IV of both hands, showed strong agreement (K=0.82) in detecting a scleroderma pattern. Similar trends were observed for detection of giant capillaries.Conclusions These findings suggest that a four-finger protocol could serve as a time-efficient alternative in clinical practice when full assessment is not feasible. While promising, results should be interpreted cautiously due to the study’s limited sample size and lack of independent diagnostic reference. Future research should validate an adaptive testing strategy incorporating high-yield fingers and rapid scoring algorithms to enhance early detection of SSc.",
  "authors": [
    {
      "affiliations": [
        "Radboudumc, Nijmegen, The Netherlands"
      ],
      "name": "Dieneke Haverkort"
    },
    {
      "affiliations": [
        "Radboudumc, Nijmegen, The Netherlands"
      ],
      "name": "Madelon Vonk"
    }
  ],
  "title": "P.237 Nailfold videocapillaroscopy in patients with suspected systemic sclerosis: a comparison of one-finger method versus eight-finger method",
  "uid": "0dc6d706-cd51-5faf-903c-4ba466485c44"
}