Fast track algorithm: How to differentiate a "scleroderma pattern" from a "non-scleroderma pattern"
EULAR Study Group on Microcirculation in Rheumatic Diseases
(2019) Autoimmunity Reviews, volume 18, issue 11
(Article)
Abstract
OBJECTIVES: This study was designed to propose a simple "Fast Track algorithm" for capillaroscopists of any level of experience to differentiate "scleroderma patterns" from "non-scleroderma patterns" on capillaroscopy and to assess its inter-rater reliability. METHODS: Based on existing definitions to categorise capillaroscopic images as "scleroderma patterns" and taking into account
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the real life variability of capillaroscopic images described standardly according to the European League Against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases, a fast track decision tree, the "Fast Track algorithm" was created by the principal expert (VS) to facilitate swift categorisation of an image as "non-scleroderma pattern (category 1)" or "scleroderma pattern (category 2)". Mean inter-rater reliability between all raters (experts/attendees) of the 8th EULAR course on capillaroscopy in Rheumatic Diseases (Genoa, 2018) and, as external validation, of the 8th European Scleroderma Trials and Research group (EUSTAR) course on systemic sclerosis (SSc) (Nijmegen, 2019) versus the principal expert, as well as reliability between the rater pairs themselves was assessed by mean Cohen's and Light's kappa coefficients. RESULTS: Mean Cohen's kappa was 1/0.96 (95% CI 0.95-0.98) for the 6 experts/135 attendees of the 8th EULAR capillaroscopy course and 1/0.94 (95% CI 0.92-0.96) for the 3 experts/85 attendees of the 8th EUSTAR SSc course. Light's kappa was 1/0.92 at the 8th EULAR capillaroscopy course, and 1/0.87 at the 8th EUSTAR SSc course. CONCLUSION: For the first time, a clinical expert based fast track decision algorithm has been developed to differentiate a "non-scleroderma" from a "scleroderma pattern" on capillaroscopic images, demonstrating excellent reliability when applied by capillaroscopists with varying levels of expertise versus the principal expert and corroborated with external validation.
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Keywords: Algorithm, Capillaroscopy, EULAR Study Group on Microcirculation in Rheumatic Diseases, Experts, Novices, Reliability, “Scleroderma patterns”, Reproducibility of Results, Humans, Microscopic Angioscopy/methods, Algorithms, Scleroderma, Systemic/diagnosis, Scleroderma, Localized/diagnosis, "Scleroderma patterns", EULAR Study Group on Microcirculation in, Rheumatic Diseases, Immunology and Allergy, Immunology, Review, Journal Article
ISSN: 1568-9972
Publisher: Elsevier
Note: Funding Information: Vanessa Smith: Prof. Smith received a research grant from Boehringer Ingelheim; and received research funding from Actelion Pharmaceuticals Ltd., Bayer AG, F. Hoffman-La Roche AG, Galapagos NV and Sanofi.Oliver Distler: Consultancy relationship and/or research funding from A. Menarini, Acceleron Pharma, Amgen, AnaMar, Bayer, Boehringer Ingelheim, Catenion, CSL Behring, Ergonex, GSK, Inventiva, Italfarmaco, iQvia, Lilly, Medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Novartis, Pfizer, Roche, Blade Therapeutics, CSL Behrings, Target Bio Science and UCB in the area of potential treatments of scleroderma and its complications. In addition, patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143).Christopher Denton: received research grants from GlaxoSmithKline, CSF Behring, and Inventiva and consulting fees from Roche/Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer-Ingelheim, UCB and Bayer.Jacob M. van Laar: received honoraria from Arthrogen, BMS, Eli Lilly, MSD, Roche, and research grants from Astra Zeneca, MSD, Roche and Thermofisher.Madelon C. Vonk: received honoraria from Boehringer Ingelheim and Roche and research grants from Actelion Pharmaceuticals Ltd. and Therabel. Funding Information: Madelon C. Vonk: received honoraria from Boehringer Ingelheim and Roche and research grants from Actelion Pharmaceuticals Ltd. and Therabel . Funding Information: Oliver Distler: Consultancy relationship and/or research funding from A. Menarini , Acceleron Pharma , Amgen , AnaMar , Bayer , Boehringer Ingelheim , Catenion , CSL Behring , Ergonex , GSK , Inventiva , Italfarmaco , iQvia , Lilly , Medac , Medscape , Mitsubishi Tanabe Pharma , MSD , Novartis , Pfizer , Roche , Blade Therapeutics , CSL Behrings , Target Bio Science and UCB in the area of potential treatments of scleroderma and its complications. In addition, patent mir-29 for the treatment of systemic sclerosis issued (US8247389, EP2331143). Funding Information: Christopher Denton: received research grants from GlaxoSmithKline , CSF Behring , and Inventiva and consulting fees from Roche/Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer-Ingelheim, UCB and Bayer. Funding Information: Vanessa Smith: Prof. Smith received a research grant from Boehringer Ingelheim ; and received research funding from Actelion Pharmaceuticals Ltd. , Bayer AG , F. Hoffman-La Roche AG , Galapagos NV and Sanofi . Funding Information: Jacob M. van Laar: received honoraria from Arthrogen, BMS, Eli Lilly, MSD, Roche, and research grants from Astra Zeneca , MSD , Roche and Thermofisher . Publisher Copyright: © 2019 The Authors
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