NVC was performed to get baseline levels in patients with systemic sclerosis—including the limited cutaneous, and diffuse cutaneous systemic sclerosis, and limited systemic forms—with the capillary patterns categorized as early, active, late, or normal, and non-specific changes.
At baseline and at a future visit one-and-a-half or two years later, a clinical evaluation was performed for nine organ systems that were rated 0 to 4 on the Medsger scale, with a score of 2 or greater considered “severe.”
The baseline NVC analysis was done on 66 consecutive subjects, with 8% categorized early, 38% as active, 41% as late, and 14% as normal, said Vanessa Smith, MD, PhD, a rheumatologist and chief of clinics at Ghent University Hospital.
Fifty-eight of the subjects came in for a follow-up visit, and analysis of organ involvement was done for 55 of them (there was missing baseline data on disease severity for three patients).
Of the seven with normal NVC baseline readings, there was no new severe involvement of organs. Of the five in the early baseline severity category, two had new severe organ involvement, along with 10 of 20 in the active group and 13 of 23 in the late group. An association was seen between worsening baseline NVC patterns and novel severe organ involvement at 1.5 to two years (p = .01).
Of those with novel severe organ involvement, most instances occurred in the peripheral vascular system (12) and the lungs (6). Overall, 25 of the 55 subjects had new severe involvement of organs.
The data in this study were underpowered to actually predict where future problems are more likely to appear. Later, researchers reperformed the analysis in 82 consecutive Italian patients, yielding a similar odds ratio as the previous study. They then had enough events to analyze peripheral vascular disease separately, and concluded that worsening scleroderma patterns at baseline can predict new future digital trophic lesions.
Dr. Smith said she hopes the study spurs other work.
“These data,” she said, “may instigate us to multicentrally, prospectively collect data to detect baseline NVC predictors of well-defined, novel future organ involvement.”
Thomas Collins is a freelance medical writer based in Florida.
