Background Microangiopathy plays a central role in the pathogenesis of systemic sclerosis (SSc). Nailfold capillaroscopy (NFC) is a useful tool for the assessment of the microcirculation in patients with Raynaud’s phenomenon (RP), and for early diagnosis of SSc.
Objectives To analyze the morphological changes of the microcirculation using videocapillaroscopy in patients with early SSc compared to patients with primary RP and definite SSc, as well as to healthy controls.
Methods This was a cross sectional study in which 211 subjects were included as followed: 80 patients with definite SSc (American College of Rheumatology classification criteria), 46 patients with early SSc (LeRoy and Medsger criteria from 2001), 40 patients with primary RP and 45 healthy controls. Videocapillaroscopy was performed using an opticalprobe under 200x magnification contact lens connected to an image analysis software (Videocap 8.14, DS-Medica, Italy). The following parameters were analyzed in eight digits of the hands (excluding thumbs) with the acquirement of 32 images per individual (4 fields per finger): number of capillaries/mm, number of enlarged and giant capillaries, microhaemorrhages, ramified capillaries and avascular score. For each parameter, a semiquantitative rating scale (0 to 3) was adopted. Besides, patients with scleroderma (SD) pattern on NFC were classified into three different patterns: early, active and late pattern.
Results Patients with early SSc had significantly higher number of capillaries/mm (9.36 ± 1.00 capillaries/mm) compared to patients with definite SSc (7.45 ± 1.69 capillaries/mm) (p<0.001). Moreover, patients with early SSc had significantly lower enlarged and giant capillaries scores as well as lower avascular score (0.43 ± 0.37, 0.03 ± 0.08 and 0.215 ± 0.37, respectively) compared to patients with definite SSc (0.78 ± 0.50, 0.20 ± 0.29 and 1.01 ± 0.72, respectively) (p<0.001). Patients with early SSc had also higher enlarged capillaries and microhaemorrhages scores, and higher avascular score compared to patients with primary RP and healthy controls (p<0.001). Besides, the number of capillaries/mm was lower in patients with early SSc compared to controls (10.12 ± 0.58 capillaries/mm) (p< 0.001). No giant capillaries were found in controls and primary RP patients. Ninety-six percent of patients with definite SSc presented the SD pattern, and 4% nonspecific microangiopathy on NFC. Among patients with early SSc, 76% had SD pattern, while 9% had nonspecific microangiopathy and 15% presented normal videocapillaroscopy. Among patients with definite SSc with SD pattern, 17% had the early pattern, 60% the active pattern, and 23% the late pattern on NFC. Among patients with early SSc with SD pattern, 37% had the early pattern, and 63% the active pattern. No patient with early SSc showed the late pattern on NFC.
Conclusions NFC showed significantly more severe morphological changes in patients with definite SSc compared to patients with early SSc, suggesting a progression of the peripheral microangiopathy along different phases of the disease. These findings may have important implications in the management of patients with early disease.
Disclosure of Interest None Declared
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