Format

Send to

Choose Destination
Arthritis Rheumatol. 2016 Oct;68(10):2527-39. doi: 10.1002/art.39718.

Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study.

Author information

1
University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino, Genoa, Italy. mcutolo@unige.it.
2
University of Manchester, Salford Royal NHS Foundation Trust, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK.
3
University Hospital, Zurich, Switzerland.
4
University Hospital, Zurich, Switzerland, and Charité University Hospital, Berlin, Germany.
5
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
6
La Tronche Hospital, Grenoble, France.
7
University of Modena and Reggio Emilia, Modena, Italy.
8
Istanbul University, Istanbul, Turkey.
9
National and Kapodistrian University of Athens, Athens, Greece.
10
Actelion Pharmaceuticals, Allschwil, Switzerland.
11
Syntax for Science, Basel, Switzerland.
12
Ghent University Hospital and Ghent University, Ghent, Belgium. vanessa.smith@ugent.be.

Abstract

OBJECTIVE:

To identify nailfold videocapillaroscopic features and other clinical risk factors for new digital ulcers (DUs) during a 6-month period in patients with systemic sclerosis (SSc).

METHODS:

In this multicenter, prospective, observational cohort study, the videoCAPillaroscopy (CAP) study, we evaluated 623 patients with SSc from 59 centers (14 countries). Patients were stratified into 2 groups: a DU history group and a no DU history group. At enrollment, patients underwent detailed nailfold videocapillaroscopic evaluation and assessment of demographic characteristics, DU status, and clinical and SSc characteristics. Risk factors for developing new DUs were assessed using univariable and multivariable logistic regression (MLR) analyses.

RESULTS:

Of the 468 patients in the DU history group (mean ± SD age 54.0 ± 13.7 years), 79.5% were female, 59.8% had limited cutaneous SSc, and 22% developed a new DU during follow-up. The strongest risk factors for new DUs identified by MLR in the DU history group included the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs (categorized as 0, 1, 2, or ≥3), and the presence of critical digital ischemia. The receiver operating characteristic (ROC) of the area under the curve (AUC) of the final MLR model was 0.738 (95% confidence interval [95% CI] 0.681-0.795). Internal validation through bootstrap generated a ROC AUC of 0.633 (95% CI 0.510-0.756).

CONCLUSION:

This international prospective study, which included detailed nailfold videocapillaroscopic evaluation and extensive clinical characterization of patients with SSc, identified the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs at enrollment, and the presence of critical digital ischemia at enrollment as risk factors for the development of new DUs.

PMID:
27111549
PMCID:
PMC5129545
DOI:
10.1002/art.39718
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center