Spotlight on scleroderma

10 January 2023

Our eLearning platform has lots of information about scleroderma.
In our interview below, Consultant Rheumatologist Dr Theresa Barnes captures why she developed an interest in scleroderma and capillaroscopy. 

Can you tell us about your current role?

My role is a mix of clinical work and digital management as I’m the Trust’s Chief Clinical Information Officer. I have a significant interest in Systemic Sclerosis. As well as being a rheumatology consultant at the Countess of Chester Hospital, I also work at Aintree University Hospital in the Systemic Sclerosis clinic.

When did you become interested in capillaroscopy?

I was running a Systemic Sclerosis (SSc) clinic and I wanted to be able to get capillaroscopy for patients who presented with late-onset Raynaud’s to assess their risk of connective tissue disease.

Working in the constraints of a district general hospital, it’s difficult to fit in capillaroscopy as an extension to the examination. I wanted to develop a service where we could get it done accurately without taking up too much clinic or clinician time.

How did you get it set up?

I worked closely with a colleague in our medical photography department and from our research fund we bought a video capillaroscope, which takes high-power and good-quality images.

We both went on the BSR nailfold capillaroscopy course and spent time in other hospitals where capillaroscopy is established. The photography department takes the images and uploads them onto the patient’s digital record; I then interpret the images. Colleagues within the Trust use it too, and we’re proposing to roll this out to the wider Mersey region.

What did you learn setting up the service?

The main challenge was getting the equipment, but capillaroscopes have developed massively since we bought ours seven years ago. You can now get good mid-range ones for around £500.

Upskilling your photography department is important, so they know what they’re looking for. Working at other centres and meeting people doing it everyday has been incredibly useful. Plus give thought to service agreements and business continuity plans for if the equipment fails or staff members leave.

What types of patients benefit most from capillaroscopy?

It’s most helpful for late-onset Raynaud’s patients, especially those who’ve had any kind of tissue damage like chilblains. In the younger age group, anyone with a history of tissue damage or positive antibodies.

What about the value of repeat capillaroscopy?

I only use it for diagnosis. I would repeat it if there had been equivocal images or if I needed to be reassured about discharge by checking there hadn’t been any progression.

What does the future look like for capillaroscopy?

It does need to become a mainstream investigation. As we’ve learned about the prompt diagnosis and treatment of rheumatoid arthritis, we need a drive for widespread capillaroscopy to see whether early diagnosis and intervention makes a difference with scleroderma.

You can learn more about scleroderma on our eLearning platform, which includes a webinar, journal articles, podcast on digital ulcers and eLearning case to test your knowledge.

Find out more about our next Nailfold Capillaroscopy course running in November 2023.