Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Progression of Microvascular Damage Through Different Nailfold Capillaroscopic Patterns in Systemic Sclerosis Patients.
Sulli1, Alberto, Ravera1, Francesca, Ruaro1, Barbara, Smith2, Vanessa, Pizzorni1, Carmen, Zampogna1, Giuseppe, Alessandri1, Elisa
Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
Systemic sclerosis (SSc) is characterised by early nailfold capillary anomalies and progressive internal organ involvement. This is a longitudinal study to investigate the transition of nailfold microangiopathy through different patterns of microvascular damage, looking for possible correlation with organ involvement, in patients with systemic sclerosis (SSc).
Forty patients (median disease duration 81 months) showing at baseline the "Early" scleroderma-pattern of microangiopathy were followed-up for a median time of 7.3 years. Transition from "Early" to "Active" to "Late" SSc patterns was evaluated by nailfold videocapillaroscopy (NVC) (to establish the pattern of microangiopathy and quantify the morphological anomalies) (12). In addition, organ involvement was yearly assessed as follows: oesophageal involvement by manometry, pulmonary function by lung volume tests, DLCO and CT; cardiac performance by Doppler echocardiography, renal function by laboratory tests and arterial Doppler echography; active or recent history of ulcers by both clinical interview and examination. Statistical analysis was performed by non-parametric tests.
At the end of the follow-up, the NVC pattern was found still "Early" in 44%, "Active" in 36%, "Late" in 15%, and "Normal" in 5% of SSc patients. In the subgroup of patients whose microangiopathy progressed from "Early" up to "Late" NVC pattern, the mean time of progression from "Early" to "Active" pattern was only 8±1 months (p=0.01), significantly shorter when compared with the mean time of progression from "Early" to "Active" pattern of the other patients (28±20 months), identifying a subset of subjects with fast progression of the microangiopathy. Clinical signs/symptoms progressed in accordance with morphological nailfold changes in 60% of the SSc patients. Both digital ulcers and oesophageal, skin, and lung involvement were found more frequently in SSc patients with either "Active", or "Late" pattern at the end of follow-up, when compared with organ involvement al baseline ("Early" NVC pattern). Both oesophageal involvement and lung disease correlated with higher NVC scores for loss of capillaries and disorganization (p<0.04); pulmonary arterial hypertension with higher scores for loss of capillaries, ramifications and disorganization (p=0.04); digital ulcers with higher scores for loss of capillaries, ramifications and disorganization (p=0.02), as well as with lower scores for giant capillaries (p=0.002).
The results confirm a dynamic transition of the nailfold microvascular damage through different patterns of microangiopathy. Patients showing a rapid progression from "Early" to "Active" NVC pattern (lower than one year) should be strictly monitored since at risk of rapid progression to the advanced ("Late") NVC pattern of microangiopathy that is associated with greater organ involvement.
To cite this abstract, please use the following information:
Sulli, Alberto, Ravera, Francesca, Ruaro, Barbara, Smith, Vanessa, Pizzorni, Carmen, Zampogna, Giuseppe, et al; Progression of Microvascular Damage Through Different Nailfold Capillaroscopic Patterns in Systemic Sclerosis Patients. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1474