Timing of transition between capillaroscopic patterns in systemic sclerosis

Objective. To investigate the timing of transition through different patterns of nailfold microvascular damage in patients with systemic sclerosis (SSc). Methods. In this medium-term longitudinal study, 38 SSc patients (median disease duration 12 months) with the early scleroderma pattern of microangiopathy seen on baseline nailfold videocapillaroscopy (NVC) were followed up by NVC for a median of 84 months. The evolution of the NVC pattern over time was monitored and recorded. Results. At the end of followup, the NVC pattern was still that of early scleroderma in 47% of the patients. The active scleroderma pattern was seen in 34%, the late scleroderma pattern in 13%, and a normal pattern in 5%. The mean +/- SD time of progression from the early to the active pattern and from the early to the late pattern was of 28 +/- 20 months and 36 +/- 29 months, respectively. In the subgroup of patients whose microangiopathy progressed from the early to the late NVC pattern, the time of progression from the early to the active pattern was only 8 +/- 1 months (P = 0.01), demonstrating that there is a subset of patients with rapid progression of microangiopathy. Clinical symptoms progressed in accordance with the nailfold morphologic changes in 60% of the SSc patients. Conclusion. The results of this longitudinal study demonstrate dynamic transition of microvascular damage through different NVC patterns of microangiopathy in +/- 50% of SSc patients. It is recommended that patients exhibiting rapid progression from the early to the active NVC pattern (< 1 year) should be monitored closely, since the evidence suggests that they are at risk of rapid progression to the advanced (late) NVC pattern of microangiopathy that is associated with further clinical manifestations of SSc