Nail-fold capillary abnormalities are associated with anti-centromere antibody and severity of digital ischaemia.
OBJECTIVE
Advances in nail-fold capillaroscopy allow capillary abnormalities to be quantified. Our aim was to investigate, in patients with SSc, the relationships between the degree of nail-fold capillary abnormality and disease subtypes (lcSSc and dcSSc), duration of RP and the presence of (i) severe digital ischaemia (as defined by previous i.v. vasodilators, debridements or amputations), (ii) a positive ACA, (iii) clinically evident calcinosis, (iv) pulmonary arterial hypertension and (v) telangiectases.


METHODS
This was a retrospective study of 176 patients. Six capillary measurements (four semi-automated and two manual) were calculated (automated width, distance between capillaries, tortuosity and derangement, and manual distance and density). Relationships between these measurements and the different clinical features of SSc were examined using multiple linear regressions (adjusted for age, sex and smoking status).


RESULTS
One hundred and forty-two patients had lcSSc and 34 had dcSSc. Sixty-eight (39%) had a history of severe digital ischaemia, 66 (38%) were anti-centromere positive, 53 (30%) had clinically evident calcinosis and 26 (15%) had an estimated pulmonary artery pressure of >30 mmHg. Positive associations were found between both automated and manually measured distance between capillaries and (i) presence of severe digital ischaemia and (ii) positive ACA, and reduced density was also associated with positive anti-centromere. Patients with moderate/severe telangiectases had wider capillaries compared with those with 'mild' lesions.


CONCLUSIONS
Both severe digital ischaemia and positive ACA are associated with measurable nail-fold capillaroscopic change, which has the potential of being an outcome measure for the structural microvascular disease associated with SSc-spectrum disorders.
The University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford M6 8HD, UK. ariane.herrick@manchester.ac.uk
Ariane L
AL
Herrick
Tonia L
TL
Moore
Andrea K
AK
Murray
Nina
N
Whidby
Joanne B
JB
Manning
Monica
M
Bhushan
Andy
A
Vail
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies; D002503:Centromere / Q000276:immunology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D007511:Ischemia / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D020678:Microscopic Angioscopy / Q000379:methods*; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013684:Telangiectasis / Q000276:immunology / Q000503:physiopathology*; D055815:Young Adult
D000906:Antibodies