Background Different studies and meta-analysis have shown that subclinical atherosclerosis (AS) and vascular complications (VC) are higher in patients with Systemic Sclerosis (SSc) than in healthy population. However, the relationship between macrovascular damage and microvascular affection has not been adequately studied by specific techniques such as capillaroscopy.
Objectives To explore the possible relation between several macrovascular disease variables (carotid doppler ultrasound, ankle-brachial index [ABI]) and capillaroscopy findings in patients with SSc.
Methods Transverse descriptive study with analytical components. Study population: a cohort of 115 patients with SSc controlled in the Rheumatology Department of a tertiary hospital. Variables: 1) clinical variables; 2) capillaroscopy study: findings of scleroderma pattern (megacapillaries, haemorrhages and avascular areas) and classification of evolving patterns according to Cutolo et. Al.; 3) vascular study: ankle-brachial index (ABI) and carotid doppler ultrasound (ESAOTE MyLab XV70, 7–12 MHz linear transducer, software RFQIMT) measuring intima-media thickness (IMT) and presence of atheroma plaques (Mannheim Consensus). A vascular surgeon measured ABI and the capillaroscopy and carotid doppler ultrasound were done by a highly experienced rheumatologist, blind to the rest of findings, in a term of 3 months after the initial evaluation. Statistical analysis: IBM-SPSS Statistics v22.0 package.
Results 115 patients where included consecutively, of which 108 were studied; with a mean age of 60,16 years (SD ±15.16); 99 women (91.7%) and 9 men (8.3%). Mean SSc evolution was 11.45 years (SD ±8.84). LSSc was most frequently diagnosed (50%), followed by SSc without scleroderma (18.5%) and, decreasingly, DSSc (16.7%), overlap syndrome (9.3%) and pre-SSc (5.6%). The mean right side IMT was 0,579 mm (SD ± 0,126), and the left side 0,657 mm (SD ± 0,158); 33,3% had atheroma plaques. In total, 37% had a pathological carotid ultrasound, and 39,8% had macrovascular damage (atheroma plaque and/or IMT >0,9 mm and/or ABI<0,9). In the capillaroscopy study, megacapillaries, haemorrhages and avascular areas were found in a 82,4%, 74,1% and 56,5% of patients, respectively. When re-classifying the findings according to Cutolo et al, 31,5% of patients showed an early pattern, 37% an active pattern and a 22,2% a late SSc pattern.
In the bivariate analysis, the existence of macrovascular affection showed an association with a capillary pattern with more avascular areas and fewer megacapillaries. Statistically, this association was significant between the presence of avascular areas and the macrovascular damage (χ2=4,412; p-value = 0,036) and the pathological carotid ultrasound (χ2=4,107; p-value = 0,043) variables. A tendency towards an association between these last two macrovascular variables and capillaroscopy patterns of major microvascular damage was seen.
Conclusions Nailfold capillaroscopy might be a useful tool to predict the presence of AS and macro vascular damage in patients with SSc.
Disclosure of Interest None declared
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