Annual nailfold videocapillaroscopy can be used to predict disease progression in systemic sclerosis, according to a report in Seminars in Arthritis & Rheumatism.
Early and diffuse alterations in the microvasculature are a key feature of systemic sclerosis, and nailfold videocapillaroscopy can detect morphologic changes that reflect such alterations, including capillary loss, neoangiogenesis, giant capillaries, microhemorrhages, and the presence of avascular areas. The technique already has an established role in diagnosing systemic sclerosis, said Jérôme Avouac, MD, of the rheumatology department at Cochin Hospital, Paris, and his associates.
Dr. Jérôme Avouac
Two contiguous fields extending over 1 mm in the middle of each nailfold, corresponding to the distal row of capillaries, were assessed for four features: the number of capillaries, the presence of giant capillaries, microhemorrhages, and neoangiogenesis (defined as meandering, ramified, branching, bushy, bizarre capillaries and those with more than two crossings). A total of 72 patients (51%) showed significant progression of at least one of these features during follow-up.
A progressive loss of capillaries over time strongly predicted overall disease progression (hazard ratio, 4.35). Other significant predictors of overall disease progression included the development of new ischemic digital ulcers (HR, 5.33), progression of lung involvement (HR, 18.53), progression of skin fibrosis (HR, 4.22), and worsening of the Medsger severity score (HR, 5.26). In addition, the presence of neoangiogenesis at baseline, but not the progression of neoangiogenesis over time, also predicted overall disease progression (HR, 2.53), the development of new ischemic digital ulcers (HR, 2.60), progression of lung involvement (HR, 7.38), and worsening of the Medsger severity score (HR, 2.72), Dr. Avouac and his associates said (Semin Arthritis Rheum. 2017 Feb 10. doi: 10.1016/j.semarthrit.2017.02.006).
These findings demonstrate that serial videocapillaroscopy, which they described as a simple, safe, noninvasive, and inexpensive imaging technique, can be used in routine follow-up of systemic sclerosis to improve risk assessment, the investigators said.
The authors reported no financial support for this study and reported having no relevant financial disclosures.