Scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients

Alberto Sulli ¹, Maria Elena Secchi ¹, Carmen Pizzorni ¹ and Maurizio Cutolo ^1*

¹ Research Laboratory and Division of Clinical Rheumatology, Dept. of Int. Med., University of Genova, Italy

^* To whom correspondence should be addressed. E-mail: mcutolo{at}unige.it.

Accepted 17 November 2007

Abstract

Background: Longitudinal study to define a scoring system to quantify the specific capillary abnormalities, as observed by capillary microscopy in systemic sclerosis (SSc).

Methods: Ninety SSc patients were evaluated by nailfold videocapillaroscopy (NVC) for an average time of 72±23 months. Enlarged and giant capillaries, haemorrhages, loss of capillaries, disorganisation of the microvascular array, and capillary ramifications were the evaluated parameters identifying the "scleroderma patterns'. A semiquantitative rating scale to score these altered microvascular parameters was adopted (score 0-3). A "microangiopathy evolution score" (sum of three scores: loss of capillaries, disorganisation of the microvascular array and capillary ramifications) was also selected to assess the progression of the vascular damage.

Results: At the end of the follow-up, the score for each NVC parameter significantly changed. The microangiopathy evolution score significantly increased in 53 out of 90 patients (59%) indicating a worsening of the microangiopathy. On the contrary, 22 patients (24%) showed a significant decrease of the evolution score suggesting an improvement of the microangiopathy and no changes were detected in 15 SSc patients (17%).

Conclusions:The capillaroscopic score was found a sensitive tool to quantify and to monitor the SSc microvascular damage. Furthermore, the microangiopathy evolution score might be used to survey the evolution of the microvascular damage, since the relative scores increase during the progression of the SSc.

Keywords: Capillaroscopy, Microangiopathy, Scoring, Systemic sclerosis, nailfold

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