Capillaroscopic findings in systemic sclerosis -- are they associated with disease duration and presence of digital ulcers?

Abstract

Purpose of the study: The aim of the study was to evaluate capillaroscopic pattern in systemic sclerosis (SSc) patients and its association with disease duration as well as with presence of digital ulcers.

Patients and methods: Thirty six patients with SSc were included in the study. The severity of Raynaud's phenomenon (RP) at the hands was assessed with VAS (100mm), and the presence of digital ulcers at the hands was documented. Nailfold capillaroscopy was performed by a videocapillaroscope.

Results and discussion: RP was found as a clinical symptom in 100% (36/36) of the examined SSc patients. In SSc patients with a duration of the disease of less than 3 years, an early phase "scleroderma type" capillaroscopic pattern was found in 50% (5/10) of the cases. In the group of SSc patients with a duration of the disease of more than 3 years, late phase scleroderma type capillaroscopic pattern was found in 26.9% (7/26) of the cases, which was characterized by the presence of extensive, "desert-like" avascular areas and neoangiogenic capillaries. Scleroderma type capillaroscopic pattern was found in 97.2% (35/36) of the cases. Digital ulcers at the hands were found in 36.1% (13/36) of the patients. In 100% of those patients with digital ulcers (13/13), an active type scleroderma like pattern was observed, which is characterized by the presence of frequent giant capillaries, hemorrhages, and avascular areas. An active type scleroderma like pattern was found in 47.2% (17/36) of the patients without digital ulcers.

Conclusion: The data show that the presence of digital ulcers at the hands of SSc patients is strongly associated with an active type scleroderma like capillaroscopic pattern. Observation of an active type scleroderma like pattern in patients without digital ulcers may therefore be used as a predictor for the development of trophic changes in the future, an indication for vasoactive medication for the prevention of the development of digital ulcers, and as an additional objective method for the evaluation of disease activity score in SSc.