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Combination of Capillaroscopic and Ultrasonographic Evaluations in Systemic Sclerosis: Results of a Cross‐Sectional Study
Author(s) -
Lescoat Alain,
Coiffier Guillaume,
Carlan Marine,
Droitcourt Catherine,
Ballerie Alice,
Cazalets Claire,
Perdriger Aleth,
Jégo Patrick
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23413
Subject(s) - medicine , confidence interval , odds ratio
Objective To compare microvascular damages on nailfold capillaroscopy ( NFC ) with macrovascular manifestations evaluated by hand power Doppler ultrasonography ( PDUS ) in systemic sclerosis ( SS c) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers, acroosteolysis, and calcinosis. Methods NFC , hand radiographs, and PDUS were systematically performed in 64 unselected SS c patients. PDUS evaluation with assessment of ulnar artery occlusion ( UAO ) and finger pulp blood flow ( FPBF ) were performed blinded for the results of radiographs and NFC . Results UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NFC (odds ratio [ OR ] 4.04 [95% confidence interval (95% CI ) 1.23–13.29]; P < 0.05, and OR 3.38 [95% CI 1.03–11.05]; P < 0.05, respectively). Digital ulcer history was associated with UAO ( OR 10.71 [95% CI 3.36–34.13]; P < 0.0001), pathologic FPBF ( OR 7.67 [95% CI 2.52–23.28]; P < 0.0001), late NFC pattern ( OR 6.33 [95% CI 2.03–19.68]; P = 0.001), and severe capillary loss ( OR 8.52 [95% CI 2.15–33.78]; P = 0.001). Acroosteolysis was also associated with UAO ( OR 15.83 [95% CI 3.95–63.54]; P < 0.0001), pathologic FPBF ( OR 5.52 [95% CI 1.71–17.90]; P = 0.003), late NFC pattern ( OR 6.86 [95% CI 2.18–21.53]; P = 0.001), and severe capillary loss ( OR 7.20 [95% CI 2.16–24.02]; P = 0.001). Calcinosis on radiographs was associated with late NFC pattern ( OR 5.41 [95% CI 1.82–16.12]; P = 0.002), severe capillary loss ( OR 12.69 [95% CI 3.14–51.26]; P < 0.0001), and UAO ( OR 3.19 [95% CI 1.14–8.92]; P = 0.025). Combination of UAO and severe capillary loss in the same patient was especially associated with digital ulcer history ( OR 18.60 [95% CI 2.24–154.34]; P = 0.001) and acroosteolysis ( OR 10.83 [95% CI 2.56–45.88]; P = 0.001). Conclusion Microvascular damages evaluated by NFC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease.