Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study

Abstract

ObjectiveTo identify nailfold videocapillaroscopic features and other clinical risk factors for new digital ulcers (DUs) during a 6‐month period in patients with systemic sclerosis (SSc).MethodsIn this multicenter, prospective, observational cohort study, the videoCAPillaroscopy (CAP) study, we evaluated 623 patients with SSc from 59 centers (14 countries). Patients were stratified into 2 groups: a DU history group and a no DU history group. At enrollment, patients underwent detailed nailfold videocapillaroscopic evaluation and assessment of demographic characteristics, DU status, and clinical and SSc characteristics. Risk factors for developing new DUs were assessed using univariable and multivariable logistic regression (MLR) analyses.ResultsOf the 468 patients in the DU history group (mean ± SD age 54.0 ± 13.7 years), 79.5% were female, 59.8% had limited cutaneous SSc, and 22% developed a new DU during follow‐up. The strongest risk factors for new DUs identified by MLR in the DU history group included the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs (categorized as 0, 1, 2, or ≥3), and the presence of critical digital ischemia. The receiver operating characteristic (ROC) of the area under the curve (AUC) of the final MLR model was 0.738 (95% confidence interval [95% CI] 0.681–0.795). Internal validation through bootstrap generated a ROC AUC of 0.633 (95% CI 0.510–0.756).ConclusionThis international prospective study, which included detailed nailfold videocapillaroscopic evaluation and extensive clinical characterization of patients with SSc, identified the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs at enrollment, and the presence of critical digital ischemia at enrollment as risk factors for the development of new DUs.

Effects of Longterm Treatment with Bosentan and Iloprost on Nailfold Absolute Capillary Number, Fingertip Blood Perfusion, and Clinical Status in Systemic Sclerosis

“…The clinical analysis over 4 years confirmed the efficacy of BOSE in preventing new DU, which in turn are known to correlate with nailfold capillary number 5,11,25,27,28,29 .…”

“…The simple count of nailfold capillaries/mm has been recently validated as the best biomarker to assess the severity of the microvascular damage and to predict DU incidence in SSc 25 .…”

Intra-and inter-observer reliability of nailfold videocapillaroscopy — A possible outcome measure for systemic sclerosis-related microangiopathy

“…Quantitative capillaroscopic parameters were recently confirmed of value in prediction of disease progression. [28][29] We are therefore optimistic that, through a combination of standardised training and increased use of automated analysis [30], the non-invasive technique of videocapillaroscopy will ultimately deliver as an outcome measure of SSc-related microangiopathy.…”

Progression of Organ Involvement in Systemic Sclerosis Patients with Persistent “Late” Nailfold Capillaroscopic Pattern of Microangiopathy: A Prospective Study

“…It has been reported that the decreased number of capillaries is associated with clinical subsets and the severity of SSc clinical complications 2,3,4,5 .…”