Mean Number of Nailfold Capillaries Is Associated with Disease Activity at 6 Months Follow-up in Systemic Sclerosis Patients

Ana Maria Gheorghiu¹, Raida Oneata², Alexandra Radu¹, Anca Briceag¹, Cristiana Draganescu¹, Cristina Vrancianu¹, Stefania Magda³, Tudor Constantinescu⁴, Alina Soare⁵, Rucsandra Dobrota⁶, Ioan Ancuta⁷, Claudia Ciofu⁷, Liviu Macovei⁷, Mihaela Milicescu⁷, Mariana Sasu⁷, Alexandra Enuica⁸, Octavian Linte⁸, Gheorghe Stan⁸, Brindus Comanescu⁸, Teodor Necsoiu⁸, Mihai Bojinca¹, Victor Stoica⁷ and Carina Mihai^7,9, ¹Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Cantacuzino Hospital, Bucharest, Romania, ²Internal Medicine and Rheumatology Department, Carol Davila University of Medicine and Pharmacy, Cantacuzino Hospital, Bucharest, Romania, ³Cardiology Department, University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, ⁴Marius Nasta National Pneumology Institute, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, ⁵Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and University Hospital Erlangen, Erlangen, Germany, ⁶Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, ⁷Carol Davila University of Medicine and Pharmacy, Cantacuzino Hospital, Bucharest, Romania, ⁸Optoelectronica, Bucharest, Romania, ⁹Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: capillaroscopy and systemic sclerosis

Session Information

Date: Sunday, October 21, 2018

Title: Systemic Sclerosis and Related Disorders – Clinical Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Nailfold capillaroscopy (NFC) is essential in the evaluation and classification of systemic sclerosis (SSc). The mean number of capillaries is considered a promising tool for assessing vascular involvement in SSc, however there is no consensus yet over how many digits should be analyzed and how.

Objective: Investigation of the associations of the mean number of capillaries, measured by NFC, with disease activity (by the EScSG activity score) and vascular involvement (digital ulcers (DUs) or history of DUs) in a single-center cohort of SSc patients.

Methods:

68 SSc patients (mean (SD) age 52.9 (11.0) years, disease duration 9.2 (7.1) years and diffuse cutaneous involvement 22 (34.2%)) fulfilling the ACR/EULAR 2013 classification criteria, were included. NFC and extensive assessment per the recommendations of EUSTAR were performed in all patients. 54 patients had a follow-up at 6 months. 8 digits were examined (II to V of both hands) by NFC; 4 images for each finger were saved. The NFC images were assessed by 2 experienced raters independently, scoring the mean number of capillaries in all fingers (m_nr/pat), in the 3^rd finger of the dominant hand (m_nr/3^rd dom) and in the 4^th finger of the non-dominant hand (m_nr/4^th non-dom) for each patient. Moreover, ‘early’, ‘active’, ‘late’ Cutolo patterns were also recorded.

Results:

2176 images were scored at baseline and 1728 at FU. The m_nr/pat at baseline ranged between 3.4-9.1, mean(SD) 5.6(1.7) for rater 1, respectively 3.3-8.9, 5.2(1.4) for rater 2.
There was good to excellent correlation (Spearman’s rho) at baseline and FU of the m_nr/pat with m_nr/3rd dom, m_nr/4th non-dom and Cutolo patterns, and fair correlation of m_nr/3rd dom with m_nr/4th non-dom and Cutolo patterns.

We found significant differences of all mean scores of capillaries between patients with and without history of DUs (Mann Whitney U test) (table 1). Using linear regression adjusted for age, gender and history of DUs, mean number of capillaries was associated with disease activity at FU (table 2).

Table 1. Differences in mean number of capillaries in patients with and without history of DUs

	History of DUs min-max; mean (SD)	Without history of DUs min-max, mean (SD)	p*
m_nr/pat rater 1	3.4-8.6; 5.04 (1.4)	3.4-9.1; 6.4 (1.8)	0.016
m_nr/3^rd dom rater 1	2.5-9.8; 4.9 (1.79)	2.3-10.3; 6.2 (2.3)	0.033
m_nr/4^th non-dom rater 1	2.0-9.0; 4.8 (1.5)	2.5-11.5; 6.0 (2.1)	0.017

*Mann-Whitney U test

Table 2. Associations between mean number of capillaries at baseline and disease activity (ESSG score 2003) at FU (linear regression)

Predictors	B (95% CI)	p
m_nr/pat rater 1	-0.03 (-0.40, 0.34)	ns
m_nr/pat rater 2	-0.45 (-0.834, -0.07)	0.022
m_nr/3^rd dom rater 1	-0.23 (-0.47, 1	0.056
m_nr/3^rd dom rater 2	-0.33 (-.62, -0.03)	0.032
m_nr/4^th non-dom rater 1	-0.11 (-0.34, 0.12)	0.346
m_nr/4^th non-dom rater 2	-0.27 (-0.57, 0.02)	0.070

Conclusion:

The mean number of capillaries had a good association with the history of DUs and predicted disease activity at 6 months follow-up. The m_nr/pat performed better in our analysis than the m_nr/3rd dom and m_nr/4th non-dom, however these could be used alternatively in clinical practice as they are less time consuming.

This work is part of the QUANTICAP project.

Disclosure: A. M. Gheorghiu, None; R. Oneata, None; A. Radu, None; A. Briceag, None; C. Draganescu, None; C. Vrancianu, None; S. Magda, None; T. Constantinescu, None; A. Soare, None; R. Dobrota, None; I. Ancuta, None; C. Ciofu, None; L. Macovei, None; M. Milicescu, None; M. Sasu, None; A. Enuica, None; O. Linte, None; G. Stan, None; B. Comanescu, None; T. Necsoiu, None; M. Bojinca, None; V. Stoica, None; C. Mihai, None.

To cite this abstract in AMA style:

Gheorghiu AM, Oneata R, Radu A, Briceag A, Draganescu C, Vrancianu C, Magda S, Constantinescu T, Soare A, Dobrota R, Ancuta I, Ciofu C, Macovei L, Milicescu M, Sasu M, Enuica A, Linte O, Stan G, Comanescu B, Necsoiu T, Bojinca M, Stoica V, Mihai C. Mean Number of Nailfold Capillaries Is Associated with Disease Activity at 6 Months Follow-up in Systemic Sclerosis Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/mean-number-of-nailfold-capillaries-is-associated-with-disease-activity-at-6-months-follow-up-in-systemic-sclerosis-patients/. Accessed .

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