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Abstract Number: 1926

Nailfold Videocapillaroscopy Patterns Associated with Calcinosis and Acro-Osteolysis in Systemic Sclerosis

Jerome Avouac1, Laetitia Morardet2, Maya Sammour3, Andre Kahan2, Antoine Feydy3 and Yannick Allanore1, 1Paris Descartes University, Rheumatology A Department and INSERM U1016, Cochin Hospital, Paris, France, 2Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France, 3Paris Descartes University, Radiology B department, Cochin Hospital, Paris, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: calcinosis, Capillaroscopy, systemic sclerosis and x-ray

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Session Information

Session Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics II: Approaches to Cardiac and Vascular Manifestations in Systemic Sclerosis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Calcinosis and acro-osteolysis are frequent in systemic sclerosis (SSc). They may be related to digital vasculopathy, which can be assessed by nailfold videocapillaroscopy (NVC). Our aim was to determine whether calcinosis and acro-osteolysis are associated with specific NVC features. 

Methods: Consecutive SSc patients were consecutively included during a 24-month period. NVC was performed and analysed by one investigator (JA) blinded for the results of X-Rays and classified as early, active and late pattern (2). Two independent investigators carried out radiological assessment on standard anteroposterior views of the hands and wrists (LM, MS), followed by a consensus reading (AF and YA). Calcinosis was defined by the presence of at least one calcification in soft tissue and acro-osteolysis by the presence of the resorption of at least one digit tip. Both were classified on X-rays as mild, moderate or severe according to their extent.

Results: 155 patients were included, with a mean age of 57±13 years and a mean disease duration of 9 ± 5 years; 65 (42%) had the diffuse cutaneous subset. 15 (10%) patients had a normal, 46 (30%) an early, 47 (30%) an active, and 47 (30%) a late NVC pattern. Regarding X-ray analysis, the kappa coefficient of inter-rater agreement was 0.75. 43 (28%) patients had calcinosis, of whom 26 (17%) had moderate or severe lesions; 25 (16%) patients had acro-osteolysis; of whom 13 (8%) had severe lesions. Patients with calcinosis were more likely to have acro-osteolysis (p=0.02), but Cramer’s V coefficient of association was 0.19, supporting low association between these variables. Patients with calcinosis and acro-osteolysis were more likely to have the late NVC pattern (p=0.04 and p<0.0001 respectively). In line with this result, significant capillary loss was observed in patients with calcinosis (4±1.9 vs. 5.5±2.4 mean capillaries/finger, p=0.001) and acro-osteolysis (2.8±1.3 vs. 5.6±2.27 capillaries/finger, p<0.001). Of note, association with the late NVC pattern was stronger (p=0.01)and capillary loss was more pronounced in patients with moderate or severe calcinosis (p<0.001).No association was observed between calcinosis and irregular enlargement of capillaries (neoangiogenesis). Conversely, neoangiogenesis was more frequently observed inpatients with severe acro-osteolysis (p=0.03).Multivariate logistic regression analysis confirmed the independent association between calcinosis (p=0.03) and acro-osteolysis (p=0.01) with the late NVC pattern, together with a modified Rodnan skin score >14 (p=0.008) and positive antitopoisomerase-I antibodies (p=0.01).

Conclusion: We show for the first time an independent association between calcinosis/acro-osteolysis and the late NVC pattern, and in particular, with reduced number of capillaries. This result suggests that these lesions may be related to the severe capillary loss observed at this stage. Acro-osteolysis, but not calcinosis, was associated with neoangiogenesis, which may suggest an attempt to compensate bone resorption. Further studies are now needed to determine whether capillaroscopy may predict the further occurrence or worsening of these lesions.


Disclosure:

J. Avouac,
None;

L. Morardet,
None;

M. Sammour,
None;

A. Kahan,
None;

A. Feydy,
None;

Y. Allanore,
None.

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