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Do worsening scleroderma capillaroscopic patterns predict future severe organ involvement? a pilot study
  1. Vanessa Smith1,
  2. Saskia Decuman1,
  3. Alberto Sulli2,
  4. Carolien Bonroy3,
  5. Yves Piettte1,
  6. Ellen Deschepper4,
  7. Filip de Keyser1,
  8. Maurizio Cutolo2
  1. 1Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
  2. 2Department of Internal Medicine, University of Genova, Research Laboratory and Academic Unit of Clinical Rheumatology, Genova, Italy
  3. 3Laboratory of Clinical Biology, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
  4. 4Biostatistics Unit, Ghent University, Ghent, Belgium
  1. Correspondence to Vanessa Smith, Department of Rheumatology, Ghent University Hospital 0K12-IB, De Pintelaan 185, B-9000, Gent, Belgium; vanessa.smith{at}ugent.be

Abstract

Objective Assessment of associations of nailfold videocapillaroscopy (NVC) scleroderma patterns (‘early’, ‘active’ and ‘late’) with future severe clinical involvement in a systemic sclerosis (SSc) population.

Methods Sixty-six consecutive patients with SSc according to the LeRoy and Medsger criteria underwent NVC assessment at baseline. Videocapillaroscopic images were classified into ‘normal’, ‘early’, ‘active’ or ‘late’ NVC pattern. Clinical evaluation was performed for nine organ systems (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart and kidney) according to the disease severity scale of Medsger (DSS) at 18–24 months of follow-up. Severe clinical involvement was defined as category 2–4 per organ of the DSS.

Results NVC patterns were significantly associated with future severe, peripheral vascular/lung involvement at 18–24 months. The OR rose steadily throughout the patterns. The OR for future severe peripheral disease based on simple/multiple (correcting for disease duration, subset and medication) logistic regression was 2.49/2.52 (95% CI 1.33 to 5.43, p=0.003/1.11 to 7.07, p=0.026) for early, 6.18/6.37 for active and 15.35/16.07 for late NVC scleroderma patterns versus the normal NVC pattern. The OR for future severe lung involvement based on simple/multiple regression was 2.54/2.33 (95% CI 1.40 to 5.22, p=0.001/1.13 to 5.52, p=0.021) for early, 6.43/5.44 for active and 16.30/12.68 for late NVC patterns.

Conclusions This pilot study is the first demonstrating an association between baseline NVC patterns and future severe, peripheral vascular and lung involvement with stronger odds according to worsening scleroderma patterns. This may indicate a putative role of capillaroscopy as a biomarker.

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Footnotes

  • Funding This capillaroscopic study has been made possible by a grant from the ‘Fonds voor Wetenschappelijk Reuma Onderzoek/Fonds de la Recherche Scientifique en Rhumatologie’. Saskia Decuman is supported by a grant from the ‘Rotary – National Association to support Disabled People’.

  • Competing interests None.

  • Ethics approval Ethical Committee of Ghent University Hospital.

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

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