Absence of Scleroderma pattern at nail fold capillaroscopy valuable in the exclusion of Scleroderma in unselected patients with Raynaud's Phenomenon

• Published in: BMC musculoskeletal disorders 2016-08, Vol.17 (1), p.342-342, Article 342
• Main Authors: Bissell, Lesley-Anne, Abignano, Giuseppina, Emery, Paul, Del Galdo, Francesco, Buch, Maya H
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibodies; Care and treatment; Clinical trials; Diagnosis; Female; Humans; Male; Microscopic Angioscopy; Middle Aged; Nails - diagnostic imaging; Patient Selection; Physiological aspects; Predictive Value of Tests; Raynaud Disease - diagnostic imaging; Retrospective Studies; Risk factors; Scleroderma (Disease); Scleroderma, Systemic - diagnostic imaging; Sensitivity and Specificity; Systemic scleroderma; Viral antibodies
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-016-1206-5

To report the predictive value of nail-fold capillaroscopy (NFC) patterns of vasculopathy for systemic sclerosis (Scleroderma; SSc) in an unselected cohort of patients with Raynaud's phenomenon (RP). Patients referred to a tertiary SSc clinic with RP were evaluated by light/video-NFC. Clinical diagnosis, details and serology were recorded. Primary RP was defined as RP with no features of connective tissue disease (CTD)/antibody. NFC patterns were determined: normal, non-specific, 'early', 'active' or 'late' SSc patterns. Fulfilment of the VEDOSS or 2013 ACR/EULAR criteria for SSc was determined following NFC assessment. Three hundred forty-seven patients were referred: mean (SD) age 47 (15.2) years. On clinical review, 54 (16 %) did not have RP, 69 (20 %) had primary RP, 52 (15 %) had SSc and 172 (50 %) had secondary RP. NFC SSc pattern was detected in 80 (23 %) patients; 37/52 with SSc, 30/172 with secondary RP, 9/69 with primary RP and 4/54 with no RP. For identifying patients who met either the VEDOSS or 2013 ACR/EULAR criteria for SSc, detection of a SSc NFC pattern had a sensitivity of 71 %, specificity 95 %, positive predictive value 84 % and negative predictive value 90 %. The absence of SSc NFC pattern in patients with RP or suspected CTD is very valuable in the exclusion of SSc.