Background/Purpose: To test the association of the severity of nailfold capillaroscopy (NFC) abnormalities with mortality in systemic sclerosis (SSc).

Methods: One hundred and seventy SSc patients underwent an extensive evaluation at baseline following a standard protocol. Capillary loss on NFC was evaluated using the avascular score (AS, ranging from 0 to 3), and the mean number of ectasias, megacapillaries, and hemorrhages per finger was also recorded. After a mean period of 9.3±4.0 years, the life status of the patients was ascertained. Univariate and multivariate Cox proportional hazards models were used for statistical analysis.

Results:  Sixty-three patients died. By univariate Cox analysis, the AS was significantly associated with mortality (HR=1.54, 95%CI: 1.13 to 2.09, p=0.006), but the association weakened after controlling for skin score and a combination variables representing results of complementary exams. However, in bivariate analysis, the AS showed a stronger association with mortality than anticentromere and antitopoisomerase I antibodies, severity of interstitial lung disease, and similar to skin score. In secondary analysis, the association of the AS with mortality was particularly strong among patients in the lowest quartile of skin score (HR=2.35, 1.08 to 5.14, P=0.032, controlled for skin score) and limited disease. Other NFC variables were not related to mortality.

Conclusion: The AS is associated with higher mortality in SSc and, despite the weakening of the association after controlling for skin score, performed better in this context than some other variables reflecting disease severity. This association was particularly strong among patients with low skin scores or limited disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nailfold-capillaroscopy-and-mortality-in-systemic-sclerosis/