SAT0237 Nailfold Capillaroscopy Findings in Scleroderma Patients – Prognostic Implications

Abstract

BackgroundNailfold capillaroscopy (NCP) is a useful tool for the diagnosis and follow-up of systemic rheumatic diseases and represents one of the best methods to evaluate microvascular abnormalities.ObjectivesTo characterize NCP findings of patients with Systemic Sclerosis (SSc), and understand how NCP associates with the presence of digital ulcers, gastrointestinal involvement, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD).MethodsNCP findings of adult patients with SSc followed-up in our center were reviewed. Demographic and clinical features were collected. Nonparametric tests were used to determine potential associations between capillaroscopy findings/patterns and the presence of digital ulcers, gastrointestinal involvement, PAH and ILD.ResultsIn total, 52 out of 103 patients with SSc had at least one NCP result available. Forty five were female (86.5%) and seven male (13.5%), the age was 56.6 ±13.2 years and disease duration 10.9 ±10.5 years. Thirty one (59.6%) had limited cutaneous SSc, seven (13.5%) diffuse cutaneous SSc, ten (19,2%) VEDOSS, three (5.8%) overlap syndromes and one (1.9%) SSc sine scleroderma. (table 1). The most frequent NCP findings were hemorrhages (54.7%) megacapillaries (54.7%), and capillary dilatations (52.8%).We found that digital ulcers were significantly associated with the existence of avascular areas (p=0.02), and with neoangiogenesis (p=0.03) in univariate analysis, but were not associated with any capillaroscopy pattern. Looking to interstitial lung disease, there is a trend for association with the presence of avascular areas (p=0.056). Only one patient had PAH confirmed by right heart catheterization. In this case NCP showed giant capillaries, neoangiogenesis and avascular areas. There was also a trend for association between avascular areas and higher values of NT pro BNP (p=0.078). Gastrointestinal involvement was not significantly associated with NCP findings (table 2).Table 1.Distribution of patients according to NCP and disease subtypesDiffuse cutaneousLimited cutaneousOverlap syndromeVEDOSSSine scleroderma(n=7)(n=31)(n=3)(n=10)(n=1)Early pattern n (%)0 (0)9 (29)1 (33)6 (60)0 (0)Active pattern n (%)1 (14.2)5 (16.1)1 (33)2 (20)0 (0)Late pattern n (%)3 (42.9)7 (22.6)0 (0)0 (0)0 (0)Nonspecific n (%)3 (42.9)8 (25.8)1 (33)1 (10)1 (100)Normal NCP n (%)0 (0)2 (6.5)0 (0)1 (11)0 (0)ConclusionsIn our study the presence of avascular areas and neoangiogenesis in NCP was significantly associated with the existence of digital ulcers. Also, ILD and higher values of NT-proBNP were more common in patients who present avascular areas. These results suggest that abnormalities detected in the NCP might help predict organ involvement, although long term follow up and greater numbers of patients are needed in order to confirm the prognostic value of NCP findings.ReferencesMannarino E, Pasqualini L, Fedeli F, Scricciolo V, Innocente S. Nailfold capillaroscopy in the screening and diagnosis of Raynaud's phenomenon. Angiology 1994; 45: 37–42Disclosure of InterestNone d...

N-terminal pro-brain natriuretic peptide in systemic sclerosis patients: correlation with nailfold capillaroscopy findings

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Prognostic value of capillaroscopy in organ involvement and identification of subtypes in systemic sclerosis (SS): A systematic literature review

“…L.C. Teixeira, in two different studies 17,18 revealed the association between stages and organ involvement. The first study was conducted from January 2013 to December 2015.…”

Valor pronóstico de la capilaroscopia en el compromiso de órganos e identificación de subtipos en la esclerosis sistémica (ES): una revisión sistemática de la literatura

“…L.C. Teixeira, in two different studies 17,18 revealed the association between stages and organ involvement. The first study was conducted from January 2013 to December 2015.…”