title: Nailfold videocapillaroscopy micro-haemorrhage and giant capillary counting as an accurate approach for a steady state definition of disease activity in systemic sclerosis.
abstract: BACKGROUND
  Nailfold videocapillaroscopy (NVC) in systemic sclerosis (SSc) is a procedure commonly used for patient classification and subsetting, but not to define disease activity (DA). This study aimed to evaluate whether the number of micro-haemorrhages (MHE), micro-thrombosis (MT), giant capillaries (GC), and normal/dilated capillaries (Cs) in NVC could predict DA in SSc.
  
  
  METHODS
  Eight-finger NVC was performed in 107 patients with SSc, and the total number of MHE/MT, GC, and the mean number of Cs were counted and defined as number of micro-haemorrhages (NEMO), GC and Cs scores, respectively. The European Scleroderma Study Group (ESSG) index constituted the gold standard for DA assessment, and scores ≥ 3.5 and = 3 were considered indicative of high and moderate activity, respectively.
  
  
  RESULTS
  NEMO and GC scores were positively correlated with ESSG index (R = 0.65, P < 0.0001, and R = 0.47, P <0.0001, respectively), whilst Cs score showed a negative correlation with that DA index (R = -0.30, P <0.001). The area under the curve (AUC) of receiver operating characteristic plots, obtained by NEMO score sensitivity and specificity values in classifying patients with ESSG index ≥ 3.5, was significantly higher than the corresponding AUC derived from either GC or Cs scores (P <0.03 and P <0.0006, respectively). A modified score, defined by the presence of a given number of MHE/MT and GC, had a good performance in classifying active patients (ESSG index ≥ 3, sensitivity 95.1%, specificity 84.8%, accuracy 88.7%).
  
  
  CONCLUSIONS
  MHE/MT and GC appear to be good indicators of DA in SSc, and enhances the role of NVC as an easy technique to identify active patients.
authors.forename: Domenico
authors.initials: D
authors.lastname: Sambataro
authors.forename: Gianluca
authors.initials: G
authors.lastname: Sambataro
authors.forename: Eleonora
authors.initials: E
authors.lastname: Zaccara
authors.forename: Wanda
authors.initials: W
authors.lastname: Maglione
authors.forename: Riccardo
authors.initials: R
authors.lastname: Polosa
authors.forename: Antonella M V
authors.initials: AM
authors.lastname: Afeltra
authors.forename: Claudio
authors.initials: C
authors.lastname: Vitali
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Del Papa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply; D006470:Hemorrhage / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D020678:Microscopic Angioscopy / Q000379:methods*; D018715:Microscopy, Video / Q000379:methods; D008875:Middle Aged; D015203:Reproducibility of Results; D012595:Scleroderma, Systemic / Q000473:pathology / Q000503:physiopathology*; D012720:Severity of Illness Index; D055815:Young Adult