Abstract
ObjectivesDespite increasing interest in nailfold capillaroscopy, objective measures of capillary structure and blood flow have been little studied. We aimed to test the hypothesis that structural measurements, capillary flow, and a combined measure have the predictive power to separate patients with systemic sclerosis (SSc) from those with primary Raynaud's phenomenon (PRP) and healthy controls (HC). Methods50 patients with SSc, 12 with PRP, and 50 HC were imaged using a novel capillaroscopy system that generates high-quality nailfold images and provides fully-automated measurements of capillary structure and blood flow (capillary density, mean width, maximum width, shape score, derangement and mean flow velocity). Population statistics summarise the differences between the three groups. Areas under ROC curves (AZ) were used to measure classification accuracy when assigning individuals to SSc and HC/PRP groups. ResultsStatistically significant differences in group means were found between patients with SSc and both HC and patients with PRP, for all measurements, e.g. mean width (μm) ± SE: 15.0 ± 0.71, 12.7 ± 0.74 and 11.8 ± 0.23 for SSc, PRP and HC respectively. Combining the five structural measurements gave better classification (AZ = 0.919 ± 0.026) than the best single measurement (mean width, AZ = 0.874 ± 0.043), whilst adding flow further improved classification (AZ = 0.930 ± 0.024). ConclusionsStructural and blood flow measurements are both able to distinguish patients with SSc from those with PRP/HC. Importantly, these hold promise as clinical trial outcome measures for treatments aimed at improving finger blood flow or microvascular remodelling.
Highlights
The value of nailfold capillaroscopy in the early diagnosis of systemic sclerosis (SSc) has long been recognised
Group means for patients with SSc were statistically significantly different from both healthy controls and patients with primary (idiopathic) Raynaud's phenomenon (PRP) for all parameters, including blood flow velocity
We have confirmed that capillaroscopic parameters allow differentiation of patients with SSc from those with PRP/healthy controls (HC)
Summary
The value of nailfold capillaroscopy in the early diagnosis of systemic sclerosis (SSc) has long been recognised. Because Raynaud's phenomenon (RP) is the most common presenting symptom of SSc, nailfold capillaroscopy is a key investigation in patients presenting with RP: abnormal nailfold capillaries allow early diagnosis of SSc (LeRoy and Medsger, 2001; Koenig et al, 2008; Matucci-Cerinic et al, 2009; Avouac et al, 2011) and are included in the 2013 American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) Classification Criteria for SSc (Van den Hoogen et al, 2013). The aim of this study was to apply this novel capillaroscopy system, incorporating flow measurements, in a cross-sectional study of patients with SSc, patients with primary (idiopathic) Raynaud's phenomenon (PRP), and healthy control subjects. Our hypothesis was that a combination of capillary flow and structural measurements would be better able to discriminate between patients with SSc and those with PRP (or healthy controls), than any single measurement
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