Background Emerging evidence demonstrate that patients with systemic sclerosis (SSc) suffer from both micro- and macrovascular disease. Structural changes in nailfold capillaries, a marker of microvascular involvement, has been associated with clinical symptoms such as digital ulcers and pulmonary arterial hypertension.
Objectives In this study we investigated the association between nailfold capillary changes and macrovascular ischemic arterial events (IAE), wich includes ischemic heart disease (IHD), ischemic peripheral vascular disease (IPVD) and ischemic cerebrovascular disease (ICVD).
Methods 163 consecutive patients fulfilling the new 2013 EULAR/ACR classification criteria for SSc participated. Widefield nailfold capillaroscopy was performed on all. Presence of enlarged capillary loops, avascular regions, and nailfold capillary density was recorded. Disease characteristics, autoantibodies, previous digital ulcers, previous IAE, the duration and severity of Raynaud's phenomenon (RP) and the echocardiographic/Doppler estimated pulmonary arterial pressure (ePAP) were tabulated.
Results Mean age was 61±13 years and 83% were female. Enlarged capillary loops or avascular regions were found in 52% and 55% respectively. Mean nailfold capillary density was 13.5±4.5 loops/3mm. 13% had a history of IAE, 17% had an ePAP>35 mmHg and 39% had a history of digital ulcers. Enlarged capillary loops were associated with a shorter disease duration and presence of anticentromere antibodies (ACA), p=0.01. Occurrence of avascular regions was associated with a longer disease- and RP duration (p<0.01), ACA (p<0.0001), digital ulcers (p<0.001) and limited cutaneous SSc (p<0.01). A low capillary density was more common among patients with a higher ePAP (p=0.03), ACA (p=0.03), digital ulcers (p<0.01) and IAE (p=0.04), especially IPVD (p=0.05).
Conclusions A low nailfold capillary density, a measure of microvascular involvement, was associated with macrovascular disease. Moreover, our results confirm that a low capillary nailfold density was associated with ACA and clinical signs of vascular involvement such as digital ulcers and a higher ePAP.
Disclosure of Interest None declared