Combination of capillaroscopic and ultrasonographic evaluations in systemic sclerosis: Results of a cross-sectional study

Objectives To compare microvascular damages on nailfold capillaroscopy (NC) with macrovascular manifestations evaluated by hand power doppler ultrasonography (PDUS) in Systemic Sclerosis (SSc) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers (DU), acro-osteolysis and Calcinosis. Methods NC, hand X-Rays and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) was performed blinded for the results of X-Rays and NC. Results UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NC (respectively OR=4.04 (1.23-13.29); p<0.05 and OR=3.38 (1.03-11.05); p<0.05). DU history was associated with UAO (OR=10.71 (3.36-34.13); p<0.0001), pathologic FPBF (OR=7.67 (2.52-23.28); p<0.0001), late pattern (OR=6.33 (2.03-19.68; p=0.001) and severe capillary loss (OR=8.52 (2.15-33.78); p=0.001). Acro-osteolysis was also associated with UAO (OR=15.83 (3.95-63.54); p<0.0001), pathologic FPBF (5.52 (1.71-17.90) p=0.003), late NC pattern (OR=6.86 (2.18-21.53); p=0.001) and severe capillary loss (OR=7.20 (2.16-24.02), p=0.001). Calcinosis on X-rays were associated with late NC pattern (OR=5.41 (1.82-16.12); p=0.002), severe capillary loss (OR=12.69 (3.14-51.26); p<0.0001) and UAO (OR=3.19 (1.14-8.92); p=0.025). Combination of UAO and severe capillary loss in a same patient was especially associated with DU history (OR=18.60 (2.24-154.34); p=0.001) and acro-osteolysis (OR=10.83 (2.56-45.88); p=0.001). Conclusions Microvascular damages evaluated by NC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease. This article is protected by copyright. All rights reserved.