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



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.



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).



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.
University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino, Genoa, Italy. mcutolo@unige.it.
Maurizio
M
Cutolo
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.
Ariane L
AL
Herrick
University Hospital, Zurich, Switzerland.
Oliver
O
Distler
University Hospital, Zurich, Switzerland, and Charité University Hospital, Berlin, Germany.
Mike O
MO
Becker
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Emma
E
Beltran
La Tronche Hospital, Grenoble, France.
Patrick
P
Carpentier
University of Modena and Reggio Emilia, Modena, Italy.
Clodoveo
C
Ferri
Istanbul University, Istanbul, Turkey.
Murat
M
Inanç
National and Kapodistrian University of Athens, Athens, Greece.
Panayiotis
P
Vlachoyiannopoulos
Actelion Pharmaceuticals, Allschwil, Switzerland.
Harbajan
H
Chadha-Boreham
Actelion Pharmaceuticals, Allschwil, Switzerland.
Emmanuelle
E
Cottreel
Actelion Pharmaceuticals, Allschwil, Switzerland.
Thomas
T
Pfister
Actelion Pharmaceuticals, Allschwil, Switzerland.
Daniel
D
Rosenberg
Syntax for Science, Basel, Switzerland.
Juan V
JV
Torres
Ghent University Hospital and Ghent University, Ghent, Belgium. vanessa.smith@ugent.be.
Vanessa
V
Smith
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005385:Fingers; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D045745:Scleroderma, Limited / Q000150:complications / Q000000981:diagnostic imaging; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging*; D012883:Skin Ulcer / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology