AB0817 Prominent nailfold capillary avascular area predicts malignancy in progressive systemic sclerosis

Background Systemic sclerosis (SSc) is an autoimmune disease characterised with proximal scleroderma and internal organ involvement. Observational studies demonstrated increased incidences of cancer in SSc patients1. Nailfold capillaroscopy is useful for the diagnosis and disease activity assessment of SSc. However, whether the nailfold capillaroscopy pattern is distinct in SSc patients with malignancy remained unknown. Objectives The aim of this study was to investigate the incidence rate of malignancy in SSc patients. Nailfold capillaroscopy morphology patterns in SSc patients with cancer were also compared to those without cancer. Methods During 2004 to 2014, consecutive 310 SSc patients who visited outpatient clinics at Taichung Veterans General Hospital, Taiwan were enrolled. Nailfold capillaroscopy was performed at a magnification of 200x. Abnormal morphology description were analysed and categorised by the scoring system proposed by Dr. Cutolo2. SSc with malignancy was defined if the subject had a cancer diagnosis during the follow-up period. Results Among 310 SSc patients, 28 (10.9%, 13 males, 25 females) patients had cancer. The mean age of SSc with malignancy is 62±10.9 years. Sixty-four percent SSc patients with cancer is diffuse type, but only 42% of them were tested positive for anti-Scl-70 antibodies. The most common cancer were genitourinary tract and gastrointestinal tract, accounting for almost two-thirds patients. Cancer and SSc were frequently diagnosed at the same year. In SSc patients with cancer, 19 patients received nailfold capillary microscope exams when SSc was diagnosed. The assessment of nailfold capillaroscopy morphology patterns in SSc patients with cancer demonstrated neither enlarged loop, giant loop, microhemorrhage nor angiogenesis. However, prominent avascular areas could be observed universally in SSc patients with malignancy. Conclusions Rheumatologists should be aware of malignancy in SSc patients, especially those with diffuse type and within the 1st year of symptoms onset. SSc patients with malignancy tend to present atypical capillaroscopic pattern of prominent avascular area without loop dilatation, microhemorrhage and angiogenesis. References [1] Bonifazi M, et al.,Rheumatology (Oxford). 2013Jan;52(1):143–54 [2] Maurizio Cutolo (2010) Atlas of Capillaroscopy in Rheumatic diseases chapter 11 page 77–86 Disclosure of Interest None declared