Background Pulmonary disease is the leading cause of mortality in patients with systemic sclerosis (SSc). Baseline gas transfer (DLCO) and FVC levels have traditionally been used as measures of disease severity and reductions in both parameters have been associated with increased mortality in the interstitial lung disease of SSc. In SSc the reduced capillary density leads to a reduced blood flow, to tissue ischemia. Tissue hypoxia usually initiates the formation of new blood vessels from the pre-existing microvasculature. Nailfold capillaroscopy is a safe, noninvasive routine way for the microvascular investigation
Objectives The aim of this study is to assess the association between capillaroscopic abnormalities and parameters of interstitial lung involvement in patients with SSc.
Methods All patients underwent routine clinical examination (dyspnea, cough, crepitus), pulmonary function tests, DLCO (alveolitis grade and fibrosis), blood gases and HRCT scan of chest (1). Microvasculature changes were assessed using nailfold videocapillaroscopy (NVC) which was performed by two independent examiners. The obtained images were analysed anonymously by two investigators blinded for the clinical and serum status of SSc patients and classified as early, active and late pattern, non specific or normal picture (2). For statistical evaluation Poisson's correlation coefficient and T-test were used.
Results Total 42 patients (38 females) were investigated: 30 individuals with limited form, 7 with diffuse, 3 patients with scleroderma sine scleroderma, 1 with overlap syndrome and 1 with undifferentiated connective tissue disease. The mean age ± standard deviation (SD) of the whole cohort was 51±22 years and the mean disease duration ± SD was 10±7 years. 3 patients (7.5%) had early NVC pattern, 12 patients (30%) had active, 10 (58%) late pattern, and 17 (37.5%) had nonspecific changes or normal picture. The patients with late NVC pattern exhibited more often mild to moderate alveolitis, decreased FEV1 and FVC and DLCO. When correlating NVC patterns with clinical findings, pulmonary function test and HRCT scans we found only an association of low significance with dyspnea and alveolitis grade (both p<0.1).
Conclusions In our study NVC patterns did not seem to correlate with severity of interstitial lung disease in SSc patients
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Acknowledgement This study was performed with support of CMH Research Projects No 00000023728.
Disclosure of Interest R. Bečvář Consultant for: Actelion, M. Tomcik: None declared, S. Skacelova: None declared, J. Stork: None declared, A. Slovakova: None declared
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