Background/Purpose: We previously demonstrated that NEMO score, i.e., the cumulative number of microhaemorrhages (MHEs) and microthrombosis (MTs) observed in nailfold videocapillaroscopy (NVC), was a good indicator of the steady state level of disease activity (DA) in patients with SSc when the European Scleroderma Study Group (EScSG) index was taken as gold standard.
Aim of the study. To verify whether the NEMO score could be (i) a valid tool to assess DA, even when the modified European Scleroderma Trials and Research (EUSTAR) index was considered as comparator; (ii) a sensitive method to capture the overtime changes of DA.

Methods: NEMO score, EScSG and EUSTAR indices were assessed at baseline (T0) and after a follow up of 6-12 months (T1) in a cohort of 98 patients affected by SSc according to ACR/EULAR 2013 criteria (48 with limited and 50 with diffuse SSc). It was preliminarily established that at least 50% of SSc patients should be active at enrolment time (score ≥3, according to the EScSG DA index). The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to measure the sensitivity and specificity of NEMO score in classifying patients with predefined level of DA ( ≥ 3.0 and ≥ 2.5 scores for EScSG and EUSTAR indices, respectively). To assess overtime changes of DA, the differences (Δ) between T0 and T1 values of NEMO score, EScSG and EUSTAR indices were calculated and compared to each other.

Results: NEMO score values were very closely correlated with the corresponding values of both EScSG and EUSTAR indices at T0 and T1 observations [p< 0.0001 in all cases with the exception of the correlation with EScSG values at T1 (p< 0.03)]. Values of the two composite DA indices were also strictly related to each other either at T0 or T1 observations (p< 0.0001). NEMO score showed a very good performance in classifying patients with predefined level of DA. AUCs of ROC curve analysis were 0.91 and 0.88 considering the respective predefined levels of EScSG and EUSTAR indices as standard measures of significant levels of DA (p< 0.0001 in both cases). Δ values of NEMO score were significantly correlated with the corresponding values of both EScSG and EUSTAR indices. Weighted Cohen’s k level of agreement between Δ values of NEMO score and those of EScSG and EUSTAR indices was moderate (0.55 and 0.60, respectively), but close to the level of good agreement ( >0.60).

Conclusion: NEMO score confirms to be a feasible, non-invasive and valid tool to assess steady state levels and overtime changes of DA in patients with SSc. Thus, this NVC evaluation can represent an alternative or complementary method to measure this disease status entity in this disorder.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nemo-score-in-nailfold-videocapillaroscopy-is-a-good-tool-to-assess-both-steady-state-levels-and-overtime-changes-of-disease-activity-in-patients-with-systemic-sclerosis-a-comparison-with-both-the-co/