Background Nail-fold capillaroscopy (NFC) patterns of vasculopathy have been well described in systemic sclerosis (SSc) but few studies have reported their predictive value in an unselected cohort of patients with Raynaud's Phenomenon (RP).
Objectives To describe the association and predictive value of NFC patterns with a clinical diagnosis of SSc.
Methods Patients (pts) referred to a tertiary Scleroderma clinic to aid in the diagnosis and management of RP were evaluated by light/video-NFC, performed by a fully trained physician. Data collected included clinical diagnosis, antibody (Ab) status, NFC findings and fulfilment of the VEDOSS or 2013 ACR/EULAR criteria for SSc. Primary RP (pRP) was defined as RP with no features of CTD/Ab. NFC patterns were determined: normal, non-specific, “early”, “active” or “late” SSc patterns as described.
Results 347 pts were referred to the NFC service between Jan 2009 and Oct 2013; mean (SD) age was 47 (15.2) yrs, 83% were female, 26% smokers (Table 1). On clinical review, 54 (15%) did not have RP, 69 (20%) had primary RP, 52 had SSc (56% ACA+ve, 8% Scl70+ve; 67% lcSSc, 10% dcSSc, 11.5% undefined, 11.5% overlap; at referral, 29% met VEDOSS criteria, 60% met 2013 ACR/EULAR criteria), and 172 (39.5%) had secondary RP (sRP).
NFC SSc pattern was detected in 80 (23%) pts: 43 with “early”, 31 with “active” and 6 with “late” pattern. 37 of the 52 patients with SSc had SSc pattern at NFC. Among the other patients with SSc pattern, 30 had sRP, 9 pRP and 4 no RP. Non-specific findings were detected in 8/52 patients with SSc, 62/172 patients with sRP, 33/69 patients with pRP and 21/54 patients with no RP. Of those without a clinical diagnosis of scleroderma (n=295), 41 (14%) met VEDOSS criteria following NFC and 4 (1.3%) the 2013 ACR/EULAR criteria for SSc. Of the 41 pts meeting VEDOSS, 28 (68%) were found to have a SSc NFC pattern.
Considering the entire unselected cohort, the detection of SSc pattern on NFC had a sensitivity of 71%, specificity 95%, positive predictive value 84% and negative predictive value 90% for identifying pts who met the VEDOSS or 2013 ACR/EULAR criteria.
Conclusions Our specialised NFC service improved the detection of SSc in an unselected cohort of pts with RP or suspected CTD. Pts meeting the new ACR/EULAR criteria are more likely to have a SSC NFC pattern than those meeting VEDOSS criteria. The absence of SSc NFC pattern in pts with RP or suspected CTD is very valuable in the exclusion of SSc.
Disclosure of Interest None declared