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Nailfold Capillary Microscopy Can Suggest Pulmonary Disease Activity in Systemic Sclerosis
MARKUS BREDEMEIER, RICARDO MACHADO XAVIER, KARINA GATZ CAPOBIANCO, VICENTE GREGÓRIO RESTELLI, LUIS EDUARDO PAIM ROHDE, ANTÔNIO FERNANDO FURLAN PINOTTI, EDUARDO HENNEMANN PITREZ, MARCELO VASCONCELOS VIEIRA, MARIA ÂNGELA FONTOURA, DOLORES HELOÍSA de CAMPOS LUDWIG, and JOÃO CARLOS TAVARES BRENOL
ABSTRACT.
Methods. Ninety-one patients with SSc were studied by means of interview, physical examination, nailfold capillary microscopy (NCM), serology, pulmonary function tests, esophageal transit scintigraphy, Doppler echocardiography, and pulmonary high resolution computed tomography (HRCT). Pulmonary disease activity was diagnosed by the observation of ground-glass opacities on pulmonary HRCT. Capillary loss on NCM was evaluated using the avascular score: patients with mean score ³ 1 or mean number of megacapillaries per finger ³ 1 were considered to have severe capillaroscopic alterations. Results. Patients with higher skin scores, longer disease duration, signs of peripheral ischemia, esophageal dysfunction, antitopoisomerase I antibodies, and ground-glass opacities had higher mean avascular scores (p £ 0.05 in all tests). The association between ground-glass opacities and higher avascular scores was particularly strong in patients with disease duration £ 5 years. Among these patients, ground-glass opacities were present in 14 of 19 patients with severe NCM alterations, but were absent in all patients (n = 8) with mild or no NCM alterations (p < 0.001). ROC curves confirmed the ability of NCM to discriminate between patients with and without ground-glass opacities among those with disease duration £ 5 years. However, NCM could not predict the presence of reduced pulmonary diffusing capacity. Conclusion. The severity of NCM abnormalities is associated with lung disease activity in SSc, particularly when the disease duration is relatively short. (J Rheumatol 2004;31:286-94) Key Indexing Terms:
SYSTEMIC SCLEROSIS
From the Divisions of Rheumatology, Cardiology, Radiology, Pneumology, and Nuclear Medicine, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. M. Bredemeier, MD, MSc; R.M. Xavier, MD, PhD, Associate Professor of Rheumatology; K.G. Capobianco, MD, MSc, Division of Rheumatology; V.G. Restelli, Medical Student; L.E.P. Rohde, MD, PhD; A.F.F. Pinotti, MD, MSc, Division of Cardiology; E.H. Pitrez, MD; M.V. Vieira, MD, PhD, Division of Radiology; M.A. Fontoura, MD, Division of Pneumology; D.H.C. Ludwig, MD, Division of Nuclear Medicine; J.C.T. Brenol, MD, PhD, Associate Professor of Rheumatology, Head, Division of Rheumatology. Supported in part by grants from Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre (FIPE/HCPA). Address reprint requests to Dr. M. Bredemeier, Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350/sala 645, Porto Alegre, RS, 90035-003, Brazil. E-mail: markbred@terra.com.br Submitted December 13, 2002; revision accepted July 29, 2003. |