학술논문
Nailfold capillaroscopy in SSc: innocent bystander or promising biomarker for novel severe organ involvement/progression?
Document Type
Article
Author
Vanhaecke, Amber; Cutolo, Maurizio; Distler, Oliver; Riccieri, Valeria; Allanore, Yannick; Denton, Christopher P; Hachulla, Eric; Ingegnoli, Francesca; Deschepper, Ellen; Avouac, Jérôme; Jordan, Suzana; Launay, David; Melsens, Karin; Pizzorni, Carmen; Sulli, Alberto; Vasile, Massimiliano; Herrick, Ariane L; Smith, Vanessa
Source
Subject
*DISEASE progression
*BIOMARKERS
*RESEARCH
*SKIN diseases
*NAILS (Anatomy)
*CAPILLARIES
*PULMONARY hypertension
*PERIPHERAL vascular diseases
*SYSTEMIC scleroderma
*MICROCIRCULATION
*MULTIPLE organ failure
*SEVERITY of illness index
*RISK assessment
*DESCRIPTIVE statistics
*ANGIOGRAPHY
*LOGISTIC regression analysis
*ODDS ratio
*HEMORRHAGE
*DISEASE risk factors
*EVALUATION
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Language
ISSN
1462-0324
Abstract
Objectives Nailfold videocapillaroscopy (NVC) plays a well-established role in differentiating primary from secondary RP due to SSc. However, the association of NVC with novel severe organ involvement/progression in SSc has never been evaluated in a multicentre, multinational study, which we now perform for the first time. Methods Follow-up data from 334 SSc patients [265 women; 18 limited SSc (lSSc)/203 lcSSc/113 dcSSc] registered between November 2008 and January 2016 by seven tertiary centres in the EUSTAR-database, were analysed. Novel severe organ involvement/progression was defined as new/progressive involvement of the peripheral vasculature, lungs, heart, skin, gastrointestinal tract, kidneys, musculoskeletal system, or death, at the 12- or 24-month follow-up. NVC images at enrolment were quantitatively and qualitatively evaluated according to the standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Uni- and multivariable logistic regression modelling (ULR, MLR) was performed. Results Of the 334 included SSc patients, 257 (76.9%) developed novel overall severe organ involvement/progression. Following MLR, normal capillary density was associated with less-frequent novel overall severe organ involvement/progression [odds ratio (OR) = 0.77, P < 0.001] and novel peripheral vascular involvement (OR = 0.79, P = 0.043); microhaemorrhages were associated with less novel pulmonary hypertension (OR = 0.47, P = 0.029); and a 'severe' (active/late) NVC pattern was associated with novel overall severe organ involvement/progression (OR = 2.14, P = 0.002) and skin progression (OR = 1.70, P = 0.049). Conclusions Our results suggest that NVC may be a promising biomarker in SSc, certainly warranting further investigation. Despite the participation of tertiary centres, which follow their patients in a standardized way, we were underpowered to detect associations with infrequent severe organ involvement/progression. [ABSTRACT FROM AUTHOR]