Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity

Objective. To evaluate in a large group of scleroderma patients, the association of nailfold videocapillaroscopic patterns with both demographic and clinical features. Methods. One hundred and three Italian patients (91 women and 12 men, mean age 54.3 years, median disease duration 7yrs, 68 with limited and 35 with diffuse subset of disease), consecutively enrolled for the study, underwent nailfold videocapillaroscopy; the microvascular alterations were classified into three different patterns, early, active and late. The nailfold videocapillaroscopic patterns were correlated with such numerous clinical features as sex, age, disease duration, disease subset, disease activity, haematochemical data, involvement of skin, heart, lung and peripheral vessels. Results. Nailfold videocapillaroscopic patterns were significantly associated with disease subsets (P=0.018). Severity of skin, lung, heart and peripheral vascular involvement progressively increased across nailfold videocapillaroscopic patterns, from early to late pattern (P<0.001 for cutaneous and peripheral vascular involvement; P=0.003 and 0.002 for lung and heart involvement, respectively) as well as homocysteine plasma levels (P= 0.02). Patients with late pattern showed an increased risk to have an active disease [OR (odds ratio) 3.50; 95% Cl (confidence interval) 1.31-9.39], to present digital ulcers (OR 5.74; 95% Cl 2.08-15.89) and moderate to severe skin (OR 5.28; 95% Cl 1.93-14.19), heart (OR 5.75; 95% Cl 2.04-16.21) and lung involvement (OR 4.41; 95% Cl 1.63-11.92). Conclusions. Our study showed that scleroderma microangiopathy correlates with disease subset and severity of peripheral vascular, skin, heart and lung involvement; patients with late pattern showed an increased risk to have an active disease and to show a moderate/severe skin or visceral involvement compared to patients with early and active patterns. Therefore nailfold videocapillaroscopy, a simple, non-invasive and non-expensive investigation, is useful in staging scleroderma patients and also provides prognostic information.