Nailfold capillary microscopy can suggest pulmonary disease activity in systemic sclerosis.
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.


CONCLUSIONS
The severity of NCM abnormalities is associated with lung disease activity in SSc, particularly when the disease duration is relatively short.
Bredemeier
Markus
M
Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. markbred@terra.com.br
Xavier
Ricardo Machado
RM
Capobianco
Karina Gatz
KG
Restelli
Vicente Gregório
VG
Rohde
Luis Eduardo paim
LE
Pinotti
Antônio Fernando Furlan
AF
Pitrez
Eduardo Hennemann
EH
Vieira
Marcelo Vasconcelos
MV
Fontoura
Maria Angela
MA
Ludwig
Dolores Heloísa de Campos
DH
Brenol
João Carlos Tavares
JC
D000328:Adult; D002196:Capillaries; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology*; D016014:Linear Models; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis*; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology