Ann Rheum Dis doi:10.1136/annrheumdis-2011-200022
  • Clinical and epidemiological research
  • Extended report

Predictive role of capillaroscopic skin ulcer risk index in systemic sclerosis: a multicentre validation study

  1. C Ferri1
  1. 1Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Modena, Italy
  2. 2Department of Internal Medicine, Rheumatology Unit, Policlinico S Orsola Malpighi, Bologna, Italy
  3. 3Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
  4. 4Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
  5. 5Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy
  6. 6Department of Clinical and Experimental Medicine, Rheumatology Unit, Second University of Naples, Napoli, Italy
  7. 7Department of Internal Medicine, Division of Rheumatology, University of Palermo, Palermo, Italy
  8. 8Department of Internal Medicine, Pugliese-Ciaccio Hospital, Catanzaro, Italy
  9. 9Internal Medicine Unit, Civitanova Marche Hospital, Civitanova Marche, Italy
  10. 10Rheumatology Unit, Department of Molecular Pathology and Innovative Therapies, Università Politecnica delle Marche, Ancona, Italy
  11. 11Unit of Statistics in Medicine, Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy
  1. Correspondence to Professor Clodoveo Ferri, Rheumatology Unit, Department of Internal Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41121 Modena, Italy; clferri{at}
  • Accepted 11 August 2011
  • Published Online First 13 September 2011


Introduction The early detection of systemic sclerosis (SSc) patients at high risk of developing digital ulcers could allow preventive treatment, with a reduction of morbidity and social costs. In 2009, a quantitative score, the capillaroscopic skin ulcer risk index (CSURI), calculated according to the formula ‘D×M/N2’, was proposed, which was highly predictive of the appearance of scleroderma digital ulcers within 3 months of capillaroscopic evaluation.

Objectives This multicentre study aims to validate the predictive value and reproducibility of CSURI in a large population of SSc patients.

Methods CSURI was analysed in 229 unselected SSc patients by nailfold videocapillaroscopy (NVC). All patients were re-evaluated 3 months later with regard to the persistence and/or appearance of new digital ulcers.

Results 57 of 229 patients presented with digital ulcers after 3 months. The receiver operating characteristic curve analysis showed an area under the curve of 0.884 (95% CI 0.835 to 0.922), with specificity and sensitivity of 81.4% (95% CI 74.8 to 86.89) and 92.98% (95% CI 83.0 to 98.0), respectively, at the cut-off value of 2.96. The reproducibility of CSURI was validated on a random sample of 81 patients, with a κ-statistic measure of interrater agreement of 0.8514.

Conclusions The role of CSURI was confirmed in detecting scleroderma patients with a significantly high risk of developing digital ulcers within the first 3 months from NVC evaluation. CSURI is the only method validated to predict the appearance of digital ulcers and its introduction into routine clinical practice might help optimise the therapeutic strategy of these harmful SSc complications.


  • Competing interests None.

  • Ethics approval Ethics approval was obtained from the ethics committee of Modena.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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