Systemic Sclerosis: Capillaroscopic and Ultrasonographic Evaluations

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In patients with systemic sclerosis, the main digital indicators of the disease include digital ulcers, acro-osteolysis, and calcinosis.
In patients with systemic sclerosis, the main digital indicators of the disease include digital ulcers, acro-osteolysis, and calcinosis.

Microvascular damage evaluated using nailfold capillaroscopy and macrovascular features that include ulnar artery occlusion (UAO) assessed using hand-power Doppler ultrasonography (PDUS) have demonstrated associations with the main digital manifestations of systemic sclerosis (SSc) — also known as scleroderma — according to a recent study published in Arthritis Care & Research.

In patients with SSc, the main digital indicators of the disease include digital ulcers, acro-osteolysis, and calcinosis. Between November 2014 and November 2015, nailfold capillaroscopy, hand radiographs, and PDUS were all performed systematically in 64 unselected, consecutive patients with SSc. Prior history of digital ulcers was noted in patients' medical records and during clinical examinations (pitting scars). PDUS evaluation with assessment of UAO and finger pulp blood flow was performed and blinded to the radiography and nailfold capillaroscopy results. All patients included in this observational and cross-sectional study were referred to the rheumatology unit at Rennes University Hospital, Rennes, France.

UAO and pathologic finger pulp blood flow were both significantly associated with severe capillary loss (<4 capillaries/mm) on nailfold capillaroscopy (odds ratio [OR], 4.04; 95% CI, 1.23-13.29; P <.05 and OR, 3.38; 95% CI, 1.03-11.05; P <.05, respectively). History of digital ulcers was significantly associated with UAO (OR, 10.71; 95% CI, 3.36-34.13; P <.0001), pathologic finger pulp blood flow (OR, 7.67; 95% CI, 2.52-23.28; P <.0001), late nailfold capillaroscopy pattern (OR, 6.33; 95% CI, 2.03-19.68; P =.001), and severe capillary loss (OR, 8.52; 95% CI, 2.15-33.78; P =.001).

Acro-osteolysis was also significantly associated with UAO (OR, 15.83; 95% CI, 3.95-63.54; P <.0001), pathologic finger pulp blood flow (OR, 5.52; 95% CI, 1.71-17.90; P =.003), late nailfold capillaroscopy pattern (OR, 6.86; 95% CI, 2.18-21.53; P =.001), and severe capillary loss (OR, 7.20; 95% CI, 2.16-24.02; P =.001). The appearance of calcinosis on radiography was significantly associated with late nailfold capillaroscopy pattern (OR, 5.41; 95% CI, 1.82-16.12; P =.002), severe capillary loss (OR, 12.69; 95% CI, 3.14-51.26; P <.0001), and UAO (OR, 3.19; 95% CI, 1.14-8.92; P =.025).

The investigators concluded that in patients with SSc, UAO is associated with digital ulcers, pitting scars, calcinosis, and acro-osteolysis. In addition, UAO and pathologic finger pulp blood flow are associated with severe capillary loss on nailfold capillaroscopy evaluation in these patients. A combination of PDUS and nailfold capillaroscopy findings may help to reveal those with SSc who have more severe vasculopathy.

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Reference

Lescoat A, Coiffier G, de Carlan M, et al. Combination of capillaroscopic and ultrasonographic evaluations in systemic sclerosis: results of a cross-sectional study [published online September 12, 2017]. Arthritis Care Res (Hoboken). doi:10.1002/acr.23413

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