Treatment with mycophenolate mofetil is associated with improved nailfold vasculature in systemic sclerosis

Abstract

Objective: To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies.

Methods: This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation.

Results: Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time.

Conclusion: Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.

Keywords: MMF; SSc; anti-topoisomerase antibody; nailfold capillaroscopy; scleroderma.

Figure 1.

Widefield nailfold capillary microscopy of two SSc patients with improved nailfold capillaries. Patient 1 (lcSSc, nucleolar ANA) is shown in (A) and (B). At baseline measurement showed 14 capillaries/3 mm on the fourth finger of the left hand and early scleroderma pattern (A). At follow-up, after treatment with MMF, the capillaries had increased to 17 capillaries/3 mm on the fourth finger of the left hand and the morphology was normal (B). Patient 2 (lcSSc, nucleolar ANA, PM-Scl100) is shown in (C) and (D). Baseline measurement showed 11 capillaries/3 mm on the fourth finger of the right hand and active scleroderma pattern (C). At follow-up, after treatment with MMF, the capillaries had increased to 18 capillaries/3 mm on the fourth finger of the right hand and the morphology was normal (D)