TY - JOUR
T1 - Abnormal Nailfold Capillaroscopy Is Common in Patients with Connective Tissue Disease and Associated with Abnormal Pulmonary Function Tests
AU - van Roon, Anniek M.
AU - Huisman, Cato C.
AU - van Roon, Arie M.
AU - Zhang, Dan
AU - Stel, Ara J.
AU - Smit, Andries J.
AU - Bootsma, Hendrika
AU - Mulder, Douwe J.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objective. To assess the presence of a systemic sclerosis (SSc) pattern on nailfold capillary microscopy (NCM) in patients with Raynaud phenomenon (RP) and to explore its association with abnormal pulmonary function tests (PFT).Methods. NCM patterns were assessed in 759 consecutive patients with RP. Patterns were classified as normal (n = 354), nonspecific (n = 159), or SSc pattern (n = 246). Abnormal PFT was defined as forced vital or diffusion capacity <70%. Patients were classified as primary RP (n = 245), or secondary: no definite diagnosis (n = 391), SSc (n = 40), primary Sjogren syndrome (pSS; n = 30), systemic lupus erythematosus (SLE; n = 30), mixed connective tissue disease (MCTD; n = 7), rheumatoid arthritis (RA; n = 15).Results. An SSc pattern on NCM was frequently observed in most patients with a definite diagnosis: SSc (88%), pSS (33%), SLE (17%), MCTD (71%), and RA (13%). In patients without definite diagnosis, 17% had a normal NCM pattern, 35% nonspecific, and 48% SSc pattern. Abnormal PFT was more frequent in patients with an SSc pattern (35.9% vs 19.5%, p = 0.002), even when corrected for SSc diagnosis (p = 0.003). Absence of an SSc pattern had high negative predictive value (88%); positive predictive values were low.Conclusion. SSc pattern on NCM is common in patients with RP, and in those with connective tissue diseases other than SSc. It is associated with a higher prevalence of abnormal PFT, independent of the presence of an SSc diagnosis. Although these data need validation in a prospective setting, they underline the importance of NCM in RP and putative value to stratify the risk of pulmonary involvement in early stages of disease.
AB - Objective. To assess the presence of a systemic sclerosis (SSc) pattern on nailfold capillary microscopy (NCM) in patients with Raynaud phenomenon (RP) and to explore its association with abnormal pulmonary function tests (PFT).Methods. NCM patterns were assessed in 759 consecutive patients with RP. Patterns were classified as normal (n = 354), nonspecific (n = 159), or SSc pattern (n = 246). Abnormal PFT was defined as forced vital or diffusion capacity <70%. Patients were classified as primary RP (n = 245), or secondary: no definite diagnosis (n = 391), SSc (n = 40), primary Sjogren syndrome (pSS; n = 30), systemic lupus erythematosus (SLE; n = 30), mixed connective tissue disease (MCTD; n = 7), rheumatoid arthritis (RA; n = 15).Results. An SSc pattern on NCM was frequently observed in most patients with a definite diagnosis: SSc (88%), pSS (33%), SLE (17%), MCTD (71%), and RA (13%). In patients without definite diagnosis, 17% had a normal NCM pattern, 35% nonspecific, and 48% SSc pattern. Abnormal PFT was more frequent in patients with an SSc pattern (35.9% vs 19.5%, p = 0.002), even when corrected for SSc diagnosis (p = 0.003). Absence of an SSc pattern had high negative predictive value (88%); positive predictive values were low.Conclusion. SSc pattern on NCM is common in patients with RP, and in those with connective tissue diseases other than SSc. It is associated with a higher prevalence of abnormal PFT, independent of the presence of an SSc diagnosis. Although these data need validation in a prospective setting, they underline the importance of NCM in RP and putative value to stratify the risk of pulmonary involvement in early stages of disease.
KW - RAYNAUD PHENOMENON
KW - MICROSCOPIC ANGIOSCOPY
KW - SYSTEMIC SCLEROSIS
KW - CONNECTIVE TISSUE DISEASES
KW - RESPIRATORY FUNCTION TESTS
KW - SYSTEMIC-LUPUS-ERYTHEMATOSUS
KW - PRIMARY SJOGRENS-SYNDROME
KW - HAND-HELD DERMATOSCOPE
KW - CLASSIFICATION CRITERIA
KW - RAYNAUDS-PHENOMENON
KW - RHEUMATOLOGY/EUROPEAN LEAGUE
KW - ORGAN INVOLVEMENT
KW - AMERICAN-COLLEGE
KW - SCLEROSIS
KW - MICROSCOPY
U2 - 10.3899/jrheum.180615
DO - 10.3899/jrheum.180615
M3 - Article
SN - 0315-162X
VL - 46
SP - 1109
EP - 1116
JO - Journal of Rheumatology
JF - Journal of Rheumatology
IS - 9
ER -