Diagnostic utility of nailfold capillaroscopy
Bibliographic record
Abstract
Abstract Aim: To determine the diagnostic utility of qualitative nailfold capillaroscopy (NC) in a clinical setting. Methods: One hundred and sixty‐seven patients, generally with Raynaud's phenomena of uncertain significance, were referred to an experienced operator for NC. NC was performed using low power wide field microscopy. Nailfold capillary arcades, number, calibre and presence of microbleeds were assessed on the third fourth and fifth nailfolds in each patient. Patients’ final diagnoses were determined by case note review following a mean of 6.6 years post‐initial NC. Results: Nailfold capillaroscopy was considered abnormal in 86/167 patients (51%), suspicious in eight, technically unsatisfactory in two and normal in the remainder. In those 86 patients with abnormal findings the follow‐up diagnosis revealed scleroderma in 79, dermatomyositis in four and antisynthetase myositis in three. Three patients with suspicious findings also developed scleroderma. Of those 71 patients with initial normal NC only four were found to have developed scleroderma at follow‐up. For a diagnosis of scleroderma NC demonstrated a sensitivity of 95%, a specificity of 91%, a positive predictive value of 92% and a negative predictive value of 94%. Nailfold capillary microbleeds were also frequently observed in patients with scleroderma, but were less specific than capillary morphological changes. Conclusion: Qualitative NC performed by an experienced operator is considered to have high diagnostic utility in the early assessment of patients with Raynaud's phenomena, and when abnormal, is highly suggestive of scleroderma, dermatomyositis or antisynthetase myositis.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".