The Utility Of Nailfold Videocapillaroscopy In Systemic Sclerosis

OBJECTIVES: To observe nailfold capillary changes in a cohort of connectivetissue disease(CTD) patients with Raynaud’s phenomenon (RP) and to determinethe diagnostic utility of nailfold videocapillaroscopy (NVC) in systemic sclerosis(SSc).To evaluate the association of NVC with visceral involvement, digital ulcerand treatment in SSc patients.MEHTODS: seventy-four CTD patients with RP were referred to an experiencedoperator for NVC, patients were divided into SSc group and non-SScgroup.tomography(CT), With the SSc patients,the results of history and physicalexaminations, lung computed lung functional tests,Doppler echocardiogram andso on were recorded..RESULTS:(1)The patients had decreased capillary loops in SSc group (P=0.011).The capillary diameter was more enlarged in SSc group than non-SSc group(P=0.000). The number of patients in SSc group with giant capillaries was18(39%), but in non-SSc group was3(6.8%)(P=0.018). There were35(72.9%)patients with haemorrhages in SSc group and in non-SSc group theywere11(42.3%)patients (P=0.017). The number of patients in SSc group withsevere effusion was21(43.8%), while in non-SSc group was3(11.5%)(P=0.005).(2) Using the Receiver Operating Characteristic (ROC) curves, indexes that theareas under the curve(AUC) at least0.7were the input capillary diameter, theoutput capillary diameter, the middle capillary diameter, blood color and effusion,and the diagnostic kits were19.5μm,25μm,20μm, deep red and severe effusion.If there are at least2out of the front3indexes, the sensitivity and specificity ofdignosis of SSc is high.(3)In the SSc group, capillary loops`number, effusion ofNVC were associated with skin diease stages, capillary loops`number, haemorrhages were associated with skin involvement evaluated by modifiedRodnan skin score (mRSS), effusion was associated with capillary loops`number,capillary diameter,blood color and giant capillary.(4) In the SSc group, nodifferences in capillary loops`number,capillary dimensions, tortuous capillaries,effusion,haemorrhages,blood color and giant capillary were present between SScpatients with pulmonary arterial hypertension (PAH)and SSc–nonPAH, betweenSSc patients with interstitial lung diseases(ILDs)and SSc–nonILDs（p>0.05）. Theproportion of patients with the capillary loops`number≤4/mm in digital ulcergroup was100%(10/10), higher than in without digital ulcer group67%(27/38)(P=0.053).(5) In the SSc group, The capillary diameter was less enlarged inpatients treated (treated with glucocorticoids and/or diease-modifyingantirheumatic drugs) than non-treated patients(P=0.037,0.056,0.077). Thetreated patients compared to non-treated patients have fast blood flow,less redcell collection,less effusion and high ratio of light red blood color.CONCLUSIONs:(1)CTD Patients with RP of SSc have less capillary loops,more enlarged capillary, more giant capillaries, more severe effusion and morehaemorrhages than non-SSc patients.The characteristics of nailfold capillarychanges particular enlarged capillary in SSc disease patients with RP can help thediagnosis and the differential diagnosis of SSc disease.(2)In the SSc group,NVCwas associated with mRSS and skin diease stages, The proportion of patients withthe loss capillary loops in digital ulcer group was higher than in without digitalulcer group.(3) SSc patients with PAH and patients with ILDs have no significantrelationship with NVC.(4)Treated SSc patients`NVC was improved,maybe NVCcan be used to evaluate the treatment effect..