OBJECTIVE: To evaluate the association of capillaroscopic alterations with end-organ damage in systemic sclerosis (SSc). METHODS: Ninety-one SSc patients were studied through interview, physical examination, nailfold capillary microscopy (NCM), serology, pulmonary function tests, esophageal transit scintigraphy, Doppler echocardiography and pulmonary highresolution computed tomography (HRCT). Capillary loss on NCM was evaluated using the avascular score (AS); patients with mean AS =1 or mean number of megacapillaries per finger =1 were considered to have severe capillaroscopic alterations for analytical purposes. Pulmonary arterial hypertension (PAH) was defined as systolic pulmonary arterial pressure =40 mmHg. RESULTS: Patients with severe NCM alterations had greater prevalence of ground-glass opacities (GGO) areas (P=0.016), reduced pulmonary diffusing capacity (P=0.026) and esophageal dysfunction (P=0.001). PAH was present only in patients with severe NCM abnormalities (P=0.114). In those with disease duration =5 years, GGO were present in 14 of 19 patients with severe NCM alterations, but were absent in all patients (n=8) with no or mild NCM alterations (P<0.001). In this subgroup, no other clinical or laboratory variable was associated with the presence of GGO. ROC curves showed a good ability of NCM to discriminate between patients with and without the combined end-point of PAH or interstitial disease in patients with disease duration =5 years. CONCLUSIONS: The severity of NCM abnormalities is associated with end-organ damage in SSc. NCM may indicate the presence of active pulmonary disease (represented by ground-glass opacities areas in HRCT) in SSc of relatively short duration.
systemic sclerosis; capillaroscopy; fibrosing alveolitis; pulmonary hypertension; computed tomography
