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Two reports underscore the importance of nailfold capillaroscopy (NFC) in scleroderma and have shown that nailfold capillary drop out was significantly associated with mortality in systemic sclerosis.
A study of 99 patients from the South Australian Scleroderma Register (SASR) followed patients from 1991 to 2015. The cohort included 99 patients with limited cutaneous SSc, 30 patients with diffuse cutaneous SSc and 23 with an overlap scleroderma syndrome. Overall there were 56 deaths.
Diffuse scleroderma had significantly greater capillary drop out compared with limited and overlap scleroderma (p<0.001). Both capillary drop out scores and antibody status were associated with mortality.
Another study from Brazil extensively studied 170 SSc patients with high-resolution computed tomography, pulmonary function tests, and Doppler echocardiography and NFC with an avascular score. After a mean of 10 years, 73 patients died. (Citation source https://buff.ly/2nIvHQW)
NFC avascular score was significantly associated with mortality (HR 1.64, p = 0.001). The NFC association with mortality was was stronger than that of race, gender, anticentromere antibodies, anti-topoisomerase I antibodies, form of disease, but had similar strength to the overall skin score in univariate analyses.
Capillary loss was associated with higher risk of death and be a useful tool in prognostic evaluation of SSc.