Authors: (including presenting author): :
Wong HY(1), Fung SY(1), Choi KYJ(1), Tsui STK(1)
Affiliation: :
(1) Medicine & Geriatrics, Princess Margaret Hospital
Keyword 1: :
Capillaroscopy
Keyword 3: :
Nurse competency
Keyword 4: :
Rheumatology
Introduction: :
Nailfold capillaroscopy is a non-invasive microscopic technique employed to evaluate the morphology of small vessels. The finding of capillary dilatation and density can differentiate Raynaud‘s phenomenon and contribute to the early diagnosis of systemic sclerosis as well as other connective tissue diseases. Historically, this procedure was mainly performed by rheumatologists, resulting in prolonged waiting times for the patients in receiving investigation. To mitigate these delays and strengthen diagnostic capacity, interdisciplinary collaboration has been encouraged. Since July 2022, nurses at PMH have been receiving formal training under the nurse-led nailfold capillaroscopy program.
Objectives: :
1.To empower nursing practice streamlining of diagnostic pathways. 2.To facilitate earlier initiation of appropriate treatment for patients. 3.To enhance the efficiency of healthcare delivery by enabling physicians.
Methodology: :
A prospective service evaluation was conducted using the clinic data from 177 patients (148 females and 29 males) who performed capillaroscopy at PMH between July 2022 and December 2025. Following each capillaroscopy, nurses provided preliminary interpretations based on a standard classification: normal (0), non- specific pattern (1), or scleroderma pattern (2). To evaluate diagnostic consistency, all capillaroscopy images were subsequently reviewed independently by a rheumatologist blinded to the nurses’ assessment. The physician’s interpretation was designated as the reference standard for this program. A contingency table was constructed comparing nurse-led versus rheumatologist classifications for scleroderma pattern versus non-scleroderma pattern.
Result & Outcome: :
The overall observed agreement between nurse-led and rheumatologist classifications was 89.8% (159/177). Cohen’s kappa was 0.76, reflecting substantial inter-rater reliability. The nurse-led assessment demonstrated a sensitivity of 93.8% and specificity of 88.4%, its utility as a screening tool and provide immediate reassurance. Following the nurse-led training program, capillaroscopy service capacity at PMH increased patient attendance steadily from 22 patients in 2022 to 80 patients in 2025. This expansion of the program’s effectiveness in shortening wait times for the patient, while simultaneously enhancing healthcare efficiency and patient satisfaction. In addition, nurses promptly flagged positive cases for early rheumatologist review and delivered essential patient education to improve health literacy and foster proactive self-management. Conclusion The nurse-led nailfold capillaroscopy training program at PMH has successfully validated the competency of rheumatology nurses, enabling earlier treatment initiation, and enhancing the efficiency of rheumatology services.
