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Nailfold videocapillaroscopy micro-haemorrhage and giant capillary counting as an accurate approach for a steady state definition of disease activity in systemic sclerosis
Authors:Domenico Sambataro  Gianluca Sambataro  Eleonora Zaccara  Wanda Maglione  Riccardo Polosa  Antonella MV Afeltra  Claudio Vitali  Nicoletta Del Papa
Affiliation:.U.O.C. Day Hospital Reumatologia, Ospedale Gaetano Pini, Via Gaetano Pini, 9-20122 Milano, Italy ;.Policlinico Universitario di Catania, Via Santa Sofia, 78, 95123 Catania, Italy ;.Policlinico Universitario Campus Bio-Medico di Roma, Via Álvaro del Portillo, 200, 00144 Rome, Italy ;.Istituto San Giuseppe, Via Alla Fonte, 7, 23900 Lecco, Italy
Abstract:

Introduction

Nailfold videocapillaroscopy (NVC) in systemic sclerosis (SSc) is a procedure commonly used for patient classification and subsetting, but not to define disease activity (DA). This study aimed to evaluate whether the number of micro-haemorrhages (MHE), micro-thrombosis (MT), giant capillaries (GC), and normal/dilated capillaries (Cs) in NVC could predict DA in SSc.

Methods

Eight-finger NVC was performed in 107 patients with SSc, and the total number of MHE/MT, GC, and the mean number of Cs were counted and defined as number of micro-haemorrhages (NEMO), GC and Cs scores, respectively. The European Scleroderma Study Group (ESSG) index constituted the gold standard for DA assessment, and scores ≥3.5 and =3 were considered indicative of high and moderate activity, respectively.

Results

NEMO and GC scores were positively correlated with ESSG index (R = 0.65, P <0.0001, and R = 0.47, P <0.0001, respectively), whilst Cs score showed a negative correlation with that DA index (R = −0.30, P <0.001). The area under the curve (AUC) of receiver operating characteristic plots, obtained by NEMO score sensitivity and specificity values in classifying patients with ESSG index ≥3.5, was significantly higher than the corresponding AUC derived from either GC or Cs scores (P <0.03 and P <0.0006, respectively). A modified score, defined by the presence of a given number of MHE/MT and GC, had a good performance in classifying active patients (ESSG index ≥3, sensitivity 95.1%, specificity 84.8%, accuracy 88.7%).

Conclusions

MHE/MT and GC appear to be good indicators of DA in SSc, and enhances the role of NVC as an easy technique to identify active patients.
Keywords:
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