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Capillary loss on nailfold capillary microscopy is associated with mortality in systemic sclerosis

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Abstract

The objective of this study is to test the association of the severity of nailfold capillaroscopy (NFC) abnormalities with mortality in systemic sclerosis (SSc). One hundred and seventy SSc patients underwent an extensive evaluation (including high-resolution computed tomography, pulmonary function tests, and Doppler echocardiography) at baseline following a standard protocol. Capillary loss on NFC was evaluated using the avascular score (AS, ranging from 0 to 3), and the mean number of ectasias, megacapillaries, and hemorrhages per finger was also recorded. After a mean period of 10.1 ± 4.9 years, the life status of the patients was ascertained. Univariate and multivariate Cox proportional hazards models were used for statistical analysis. Overall, 73 patients died. By univariate Cox analysis, the AS was significantly associated with mortality (hazard ratio [HR] = 1.64, 95% CI 1.22 to 2.19, p = 0.001). In our study, this association was stronger than that of race, gender, anticentromere antibodies, anti-topoisomerase I antibodies, and form of disease and had similar strength to that of skin score in univariate analyses. However, after controlling for a combination of variables (age, skin score, gender, race, signs of peripheral ischemia, and extent of interstitial lung disease, all independently associated with mortality), the association of AS with mortality was blunted (HR = 1.15, 95% CI 0.80 to 1.65, p = 0.445). Other NFC variables were not related to mortality. AS was associated with higher risk of death and, despite not having an independent association with mortality after controlling for a set of demographic and clinical variables, may be a useful tool in prognostic evaluation of SSc.

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Authors and Affiliations

  1. Rheumatology Service at the Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350, sala 645, Porto Alegre, RS, 90035-903, Brazil

    Thais Rohde Pavan, Vanessa Hax, Rafael da Silva Mendonça Chakr & Ricardo Machado Xavier

  2. Rheumatology Service at the Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil

    Markus Bredemeier

  3. Rheumatology Service at the Hospital Moinhos de Vento, Porto Alegre, RS, Brazil

    Karina Gatz Capobianco

Authors
  1. Thais Rohde Pavan
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  2. Markus Bredemeier
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  3. Vanessa Hax
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  4. Karina Gatz Capobianco
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  5. Rafael da Silva Mendonça Chakr
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  6. Ricardo Machado Xavier
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Corresponding author

Correspondence to Vanessa Hax.

Ethics declarations

All patients signed an informed consent before entering the study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983.

Conflicts of interest

MB and KGC are professionally involved in performing nailfold capillaroscopy. Other authors declare no conflict of interest.

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Pavan, T.R., Bredemeier, M., Hax, V. et al. Capillary loss on nailfold capillary microscopy is associated with mortality in systemic sclerosis. Clin Rheumatol 37, 475–481 (2018). https://doi.org/10.1007/s10067-017-3869-1

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  • DOI: https://doi.org/10.1007/s10067-017-3869-1

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