1. Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study
- Author
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Cutolo, Maurizio, Herrick, Ariane L., Distler, Oliver, Becker, Mike O., Beltran, Emma, Carpentier, Patrick, Ferri, Clodoveo, Inanç, Murat, Vlachoyiannopoulos, Panayiotis, Chadha‐Boreham, Harbajan, Cottreel, Emmanuelle, Pfister, Thomas, Rosenberg, Daniel, Torres, Juan V., Smith, Vanessa, Becker, Mike, Erlacher, L, Hirschl, M, Kiener, HP, Pilger, E, Smith, V, Blockmans, D, Wautrecht, J‐C, Becvár, R, Carpentier, P, Frances, C, Lok, C, Sparsa, A, Hachulla, E, Quere, I, Allanore, Y, Agard, C, Riemekasten, G, Hunzelmann, N, Stücker, M, Ahmadi‐Simab, K, Sunderkötter, C, Wohlrab, J, Müller‐Ladner, U, Schneider, M, Vlachoyianopoulos, P, Vassilopoulos, D, Drosos, A, Antonopoulos, A, Balbir‐Gurman, A, Langevitz, P, Rosner, I, Levy, Y, Cutolo, M, Bombardieri, S, Ferraccioli, G, Mazzuca, S, Grassi, W, Lunardi, C, Airó, P, Riccieri, V, Voskuyl, AE, Schuerwegh, A, Santos, L, Rodrigues, AC, Grilo, A, Amaral, MC, Román Ivorra, JA, Castellvi, I, Distler, O, Spertini, F, Müller, R, Inanç, M, Oksel, F, Turkcapar, N, Herrick, A, Denton, C, McHugh, N, Chattopadhyay, C, Hall, F, Buch, M, University of Zurich, and Cutolo, Maurizio
- Subjects
0301 basic medicine ,Male ,EUSTAR DATABASE ,Settore MED/16 - REUMATOLOGIA ,RAYNAUDS-PHENOMENON ,PREDICTION ,2745 Rheumatology ,Logistic regression ,Microscopic Angioscopy ,Cohort Studies ,0302 clinical medicine ,Risk Factors ,Medicine and Health Sciences ,Immunology and Allergy ,Prospective Studies ,Prospective cohort study ,digital ulcers, systemic sclerosis, nailfold capillaroscopy ,Peripheral Vascular Diseases ,Digital Ulcers ,10051 Rheumatology Clinic and Institute of Physical Medicine ,Area under the curve ,VASCULAR-DISEASE ,Middle Aged ,MICROVASCULAR DAMAGE ,2723 Immunology and Allergy ,digital ulcers ,Rheumatology ,Immunology ,Female ,medicine.symptom ,SEVERE ORGAN INVOLVEMENT ,Cohort study ,Adult ,PULMONARY ARTERIAL-HYPERTENSION ,medicine.medical_specialty ,nailfold capillaroscopy ,610 Medicine & health ,CAPILLAROSCOPIC ANALYSIS ,Systemic Sclerosis ,Fingers ,03 medical and health sciences ,Videocapillaroscopy, Digital Ulcers, Systemic Sclerosis ,Scleroderma, Limited ,Internal medicine ,Skin Ulcer ,medicine ,Humans ,Videocapillaroscopy ,Aged ,030203 arthritis & rheumatology ,2403 Immunology ,Scleroderma, Systemic ,ENDOTHELIN RECEPTOR ANTAGONIST ,Receiver operating characteristic ,business.industry ,Skin ulcer ,Confidence interval ,Surgery ,030104 developmental biology ,ROC Curve ,Observational study ,EULAR SCLERODERMA TRIALS ,business - Abstract
Objective To identify nailfold videocapillaroscopic features and other clinical risk factors for new digital ulcers (DUs) during a 6-month period in patients with systemic sclerosis (SSc). Methods In this multicenter, prospective, observational cohort study, the videoCAPillaroscopy (CAP) study, we evaluated 623 patients with SSc from 59 centers (14 countries). Patients were stratified into 2 groups: a DU history group and a no DU history group. At enrollment, patients underwent detailed nailfold videocapillaroscopic evaluation and assessment of demographic characteristics, DU status, and clinical and SSc characteristics. Risk factors for developing new DUs were assessed using univariable and multivariable logistic regression (MLR) analyses. Results Of the 468 patients in the DU history group (mean ± SD age 54.0 ± 13.7 years), 79.5% were female, 59.8% had limited cutaneous SSc, and 22% developed a new DU during follow-up. The strongest risk factors for new DUs identified by MLR in the DU history group included the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs (categorized as 0, 1, 2, or ≥3), and the presence of critical digital ischemia. The receiver operating characteristic (ROC) of the area under the curve (AUC) of the final MLR model was 0.738 (95% confidence interval [95% CI] 0.681–0.795). Internal validation through bootstrap generated a ROC AUC of 0.633 (95% CI 0.510–0.756). Conclusion This international prospective study, which included detailed nailfold videocapillaroscopic evaluation and extensive clinical characterization of patients with SSc, identified the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs at enrollment, and the presence of critical digital ischemia at enrollment as risk factors for the development of new DUs.
- Published
- 2016