The relationship of nailfold capillaroscopy patterns with clinical features, functional status, pain and fatigue in patients with systemic sclerosis

Abstract

Aim: To identify the frequency of scleroderma-type capillaroscopic patterns and evaluate the association of capillaroscopic patterns with clinical parameters, functional status, fatigue, and pain in systemic sclerosis (SSc). Material and Method: This cross-sectional study included SSc patients consecutively between January 2017 and January 2019. Cutaneous involvement was evaluated with the modified Rodnan skin score (mRSS). The presence of digital ulcers, Raynaud phenomenon, interstitial lung disease, pulmonary hypertension, cardiac, gastrointestinal system (GIS), renal, joint and muscle involvement were recorded. The severity of the Raynaud phenomenon, fatigue, pain, and patient global assessment (PGA) was assessed on the Visual Analogue Scale (VAS). The Health Assessment Questionnaire (HAQ) and the Duruoz Hand Index (DHI) were used to assess physical disability and hand function, respectively. Nailfold videocapillaroscopic examinations of the patients were performed, and they were classified into four groups, including normal/non-specific, early, active, and late scleroderma patterns. Results: The mean age of 32 patients with SSc (31 female, one male) was 48.93±12.77. Anormal capillaroscopic examination findings were detected in 93.7% of the patients, and the most common capillaroscopic pattern was the active pattern. The comparison of scleroderma pattern groups revealed no difference in age (p=0.224), but disease duration was shorter in the early pattern group (p=0.005). The duration and severity of the Raynaud phenomenon, and mean mRSS were lower in the early pattern group (p=0.004, p=0.009, and p=0.001, respectively). The digital ulcer (p=0.011) and diffuse cutaneous SSc (p=0.016) were more common in the late pattern group. The percentage of pulmonary hypertension (p=0.011), GIS involvement (p<0.001), and arthralgia (p=0.027) were higher in the late pattern group. Fatigue (p=0.575), pain (p=0.536), PGA (p=0.861), HAQ (p=0.164) and DHI (p=0.064) scores were not different between the capillaroscopy pattern groups. Conclusion: Digital ulcer, pulmonary hypertension, and GIS involvement were more common in SSc patients with the late pattern. The fatigue, pain, physical disability, and hand function were similar between capillaroscopy pattern groups.

Keywords

• Scleroderma
• nailfold capillaroscopy
• functional status

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