Background/Purpose: Nailfold videocapillaroscopy (NVC) is a simple, non-invasive and inexpensive imaging technique that allows a detailed assessment of skin microcirculation. Although NVC has face and content validity for the detection of microvascular damages related to systemic sclerosis (SSc), its sensitivity to change has not been assessed in detail. Our aim was to determine in a prospective cohort the merit of NVC to detect meaningful changes over time and whether these changes are associated with disease progression.

Methods: A prospective cohort of 140 SSc patients was recruited over a 12-month period and was followed up on an annual basis for 3 years. NVC was performed at inclusion and repeated once a year by four investigators (ET, GL, CH and AV) according to a standardized procedure. NVC pictures were analysed by one investigator (JA) and classified as early, active and late patterns. Organ progression was defined according to validated definitions. The worsening of the Medsger severity scale (from category 1-2 to category 3-4) was considered as a marker of disease progression. 

Results: The mean ± standard deviation (SD) age of the 140 patients (111 women) was 56±11 year old and the mean ± SD disease duration was 9±8 years at baseline. 55 patients had the diffuse cutaneous subset. At least 3 annual NVC evaluations were available for each patient. A change of NVC pattern was observed in 29 SSc patients (21%) during the follow-up period.

A progression from a normal or early NVC pattern to an active NVC pattern was detected in 15 patients (10%). Patients who progressed to the active NVC pattern were more likely to have shorter disease duration (6±7 years vs. 11±9 years, p=0.03). Progression was independent of age, gender, cutaneous subset, past or current digital ulcers (DU), and use of vasodilators at baseline. Patients who progressed to the active NVC pattern were significantly less at risk to develop ischemic DU during follow-up (hazard ratio, HR: 0.78, 95% Confidence Interval, CI 0.17-0.95).

A progression to a late NVC pattern was observed in 14 patients (10%). Patients with the diffuse cutaneous subset and with precapillary PAH at baseline were more likely to progress to a late NVC pattern (HR: 2.39, 95% CI 1.03-7.10 and HR: 13.30, 95% CI 2.46-71.99, respectively). Progression to the late pattern was independent of age, sex, disease duration, past or current DU, and use of vasodilators at baseline. Progression to a late NVC pattern was associated with the occurrence of new ischemic DU (HR: 4.51, 95% CI 1.68-12.14), lung vascular progression (HR: 5.12 95% CI 1.23-21.27), progression of skin fibrosis (HR: 3.70, 95% CI 1.14-11.94) and worsening of Medsger disease severity scale (HR: 4.47, 95% CI 1.63-12.26).

Conclusion: Change of the NVC pattern was observed in 20% of patient with SSc during a follow-up of 3 years. NVC has the ability to detect meaningful changes over time associated with markers of disease progression. Our results support the use of NVC for the routine follow-up of SSc patients in order to improve their risk stratification. NVC might be used in the future to select high-risk patients and change to a late NVC pattern might be regarded as potential surrogate marker for disease severity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/sensitivity-to-change-of-nailfold-videocapillaroscopy-and-relationship-with-disease-progression/