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Nailfold capillaroscopy for day-to-day clinical use: construction of a simple scoring modality as a clinical prognostic index for digital trophic lesions
  1. Vanessa Smith1,
  2. Filip De Keyser1,
  3. Carmen Pizzorni2,
  4. Jens T Van Praet1,
  5. Saskia Decuman1,
  6. Alberto Sulli2,
  7. Ellen Deschepper3,
  8. Maurizio Cutolo2
  1. 1Department of Rheumatology, Ghent University Hospital, Belgium
  2. 2Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
  3. 3Biostatistics Unit, Ghent University Hospital, Belgium
  1. Correspondence to Vanessa Smith, Department of Rheumatology, Ghent University Hospital 0K12-IB, De Pintelaan 185, B-9000, Ghent, Belgium; vanessa.smith{at}


Objective Construction of a simple nailfold videocapillaroscopic (NVC) scoring modality as a prognostic index for digital trophic lesions for day-to-day clinical use.

Methods An association with a single simple (semi)-quantitatively scored NVC parameter, mean score of capillary loss, was explored in 71 consecutive patients with systemic sclerosis (SSc), and reliable reduction in the number of investigated fields (F32–F16–F8–F4). The cut-off value of the prognostic index (mean score of capillary loss calculated over a reduced number of fields) for present/future digital trophic lesions was selected by receiver operating curve (ROC) analysis.

Results Reduction in the number of fields for mean score of capillary loss was reliable from F32 to F8 (intraclass correlation coefficient of F16/F32: 0.97; F8/F32: 0.90). Based on ROC analysis, a prognostic index (mean score of capillary loss as calculated over F8) with a cut-off value of 1.67 is proposed. This value has a sensitivity of 72.22/70.00, specificity of 70.59/69.77, positive likelihood ratio of 2.46/2.32 and a negative likelihood ratio of 0.39/0.43 for present/future digital trophic lesions.

Conclusions A simple prognostic index for digital trophic lesions for daily use in SSc clinics is proposed, limited to the mean score of capillary loss as calculated over eight fields (8 fingers, 1 field per finger).

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  • VS, FDeK and CP contributed equally to this work.

  • 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’. JTVanP is supported by a research grant from the Fund for Scientific Research-Flanders. SD is supported by a grant from the Rotary – National Association to support Disabled People.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Ghent University Hospital.

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