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Presentation Number: 1874
Patients and Methods: 220 patients were diagnosed of SSc between 1979 and 2005 in our rheumatology department (University Hospital referral centre). We selected all SSc patients with a nailfold capillaroscopy performed during the regular clinical evaluation at their first visit to our clinic. In every case, capillaroscopy was performed with a 20-40x microscopy by the same observer (PEC). The following findings were considered pathologic: loss of capillaries >20%; hemorrhages (2 o more hemorrhages in at least 2 different fingers; and enlarged capillaries (2 or more capillaries with double caliber in at least 2 different fingers). No specific capillary measurements were made in any case. Mean capillaroscopy time was 5 minutes. Demographic data (age, gender, follow-up, death), clinical features (skin disease, ESR, lung, renal, cardiac, muscular, articular and gastrointestinal disease) and serological features (ANA, ACA, Scl70, a-RNP, RF, Ro, La, Sm) were obtained from the charts. Descriptive statistical, univariate and multivariate logistic regression with OR with 95% confidence interval were used.
Results: From the 220 SSc patients, 149 had a suitable nailfold capillaroscopy, without any differences between patients included or not in the study. From these 149 patients (130 F, 19 M), 86 (58%) had limited SSc, 47 (32%) diffuse SSc and 16 (10%) SSc/overlap. Age at initial symptom and diagnosis were 42±19 and 48±18 years, respectively, and duration of disease until capillaroscopy was 7±9 years. Capillaroscopy was normal in 18% of patients and abnormal in 82% (capillary loss 50%, hemorrhages 32%, capillary enlargement 59%). Univariate analysis showed: abnormal capillaroscopy was associated with diffuse SSc (p=0.005), ischemic ulcers (p<0.0001), PHT (p=0.037), Scl70 (p=0.006) and lung disease (p=0.02). Capillary loss was associated with diffuse SSc (p<0.0001), ischemic ulcers (p<0.0001), lung fibrosis (p=0.0001), Scl70 (p<0.0001) and ACA negative (p=0.002). Hemorrhages were associated with female gender (p=0.01), diffuse SSc (p=0.02), arthritis (p=0.01) and a-Scl70 (p=0.003). Enlarged capillaries were associated with female (p=0.004), PHT (p=0.004), ACA (p=0.001), and a-DNA (p=0.014) and tended to be associated with SmB (p=0.056). Multivariate analysis showed: a pathologic capillaroscopy was associated with ischemic ulcers (p=0.004) and PHT (p=0.05); capillary loss with diffuse SSc (p=0.003), ischemic ulcers (p=0.03) and Scl70 (p=0.02), hemorrhages with Scl70 (p=0.01) and enlarged capillaries with female gender (p=0.04), ACA (p=0.01) and PHT (p=0.009). The presence of the 3 findings in the same patient was associated with pulmonary fibrosis (p=0.02).
Conclusion: Nail fold capillaroscopy performed in a routine clinical setting, without any special measurement, is an inexpensive and useful technique in patients with clinical suspicion of SSc diagnosis, and may identify patients with severe visceral complications.
Results: From the 220 SSc patients, 149 had a suitable nailfold capillaroscopy, without any differences between patients included or not in the study. From these 149 patients (130 F, 19 M), 86 (58%) had limited SSc, 47 (32%) diffuse SSc and 16 (10%) SSc/overlap. Age at initial symptom and diagnosis were 42±19 and 48±18 years, respectively, and duration of disease until capillaroscopy was 7±9 years. Capillaroscopy was normal in 18% of patients and abnormal in 82% (capillary loss 50%, hemorrhages 32%, capillary enlargement 59%). Univariate analysis showed: abnormal capillaroscopy was associated with diffuse SSc (p=0.005), ischemic ulcers (p<0.0001), PHT (p=0.037), Scl70 (p=0.006) and lung disease (p=0.02). Capillary loss was associated with diffuse SSc (p<0.0001), ischemic ulcers (p<0.0001), lung fibrosis (p=0.0001), Scl70 (p<0.0001) and ACA negative (p=0.002). Hemorrhages were associated with female gender (p=0.01), diffuse SSc (p=0.02), arthritis (p=0.01) and a-Scl70 (p=0.003). Enlarged capillaries were associated with female (p=0.004), PHT (p=0.004), ACA (p=0.001), and a-DNA (p=0.014) and tended to be associated with SmB (p=0.056). Multivariate analysis showed: a pathologic capillaroscopy was associated with ischemic ulcers (p=0.004) and PHT (p=0.05); capillary loss with diffuse SSc (p=0.003), ischemic ulcers (p=0.03) and Scl70 (p=0.02), hemorrhages with Scl70 (p=0.01) and enlarged capillaries with female gender (p=0.04), ACA (p=0.01) and PHT (p=0.009). The presence of the 3 findings in the same patient was associated with pulmonary fibrosis (p=0.02).
Conclusion: Nail fold capillaroscopy performed in a routine clinical setting, without any special measurement, is an inexpensive and useful technique in patients with clinical suspicion of SSc diagnosis, and may identify patients with severe visceral complications.
B.E. Joven, None; R. Almodovar, None; A. Movasat, None; P.E. Carreira, None.