Nailfold capillary microscopy can suggest pulmonary disease activity in systemic sclerosis

• Published in: Journal of rheumatology Vol. 31; no. 2; pp. 286 - 294
• Main Authors: BREDEMEIER, Markus, MACHADO XAVIER, Ricardo, TAVARES BRENOL, Joao Carlos, GATZ CAPOBIANCO, Karina, RESTELLI, Vicente Gregorio, PAIM ROHDE, Luis Eduardo, FURLAN PINOTTI, Antonio Fernando, HENNEMANN PITREZ, Eduardo, VASCONCELOS VIEIRA, Marcelo, FONTOURA, Maria Angela, DE CAMPOS LUDWIG, Dolores Heloisa
• Format: Journal Article
• Language: English
• Published: Toronto, ON The Journal of Rheumatology 01-02-2004; Journal of Rheumatology Publishing
• Subjects: Adult; Biological and medical sciences; Capillaries; Diseases of the osteoarticular system; Female; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Linear Models; Male; Medical sciences; Microscopy - methods; Middle Aged; Nails - blood supply; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Systemic - complications; Scleroderma, Systemic - diagnosis; Severity of Illness Index; Skin Diseases - diagnosis; Skin Diseases - etiology; Radionuclide study; Doppler ultrasound study; High resolution; Cardiovascular disease; Autoimmune disease; Serology; Scintigraphy; Interview; Lung function; Systemic disease; SYSTEMIC SCLEROSIS CAPILLAROSCOPY FIBROSING ALVEOLITIS PULMONARY HYPERTENSION COMPUTED TOMOGRAPHY; Diagnosis; Scleroderma; Sonography; Human; Connective tissue disease; Lung disease; Echocardiography; Radiodiagnosis; Respiratory disease; Critically ill; Method; Esophagus; Microscopy; Medical imagery; Computerized axial tomography
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To evaluate the association of capillaroscopic alterations with pulmonary disease activity in systemic sclerosis
(SSc). METHODS: Ninety-one patients with SSc were studied by means of interview, physical examination, nailfold capillary
microscopy (NCM), serology, pulmonary function tests, esophageal transit scintigraphy, Doppler echocardiography, and pulmonary
high resolution computed tomography (HRCT). Pulmonary disease activity was diagnosed by the observation of ground-glass opacities
on pulmonary HRCT. Capillary loss on NCM was evaluated using the avascular score: patients with mean score > or = 1 or mean
number of megacapillaries per finger > or = 1 were considered to have severe capillaroscopic alterations. RESULTS: Patients
with higher skin scores, longer disease duration, signs of peripheral ischemia, esophageal dysfunction, antitopoisomerase
I antibodies, and ground-glass opacities had higher mean avascular scores (p < or = 0.05 in all tests). The association between
ground-glass opacities and higher avascular scores was particularly strong in patients with disease duration < or = 5 years.
Among these patients, ground-glass opacities were present in 14 of 19 patients with severe NCM alterations, but were absent
in all patients (n = 8) with mild or no NCM alterations (p < 0.001). ROC curves confirmed the ability of NCM to discriminate
between patients with and without ground-glass opacities among those with disease duration < or = 5 years. However, NCM could
not predict the presence of reduced pulmonary diffusing capacity. CONCLUSION: The severity of NCM abnormalities is associated
with lung disease activity in SSc, particularly when the disease duration is relatively short.