@article{3001324,
    title = "Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study",
    author = "Cutolo, M. and Herrick, A.L. and Distler, O. and Becker, M.O. and Beltran, E. and Carpentier, P. and Ferri, C. and Inanç, M. and Vlachoyiannopoulos, P. and Chadha-Boreham, H. and Cottreel, E. and Pfister, T. and Rosenberg, D. and Torres, J.V. and Smith, V. and Erlacher, L. and Hirschl, M. and Kiener, H.P. and Pilger, E. and Blockmans, D. and Wautrecht, J.-C. and Becvár, R. and Frances, C. and Lok, C. and Sparsa, A. and Hachulla, E. and Quere, I. and Allanore, Y. and Agard, C. and Riemekasten, G. and Hunzelmann, N. and Stücker, M. and Ahmadi-Simab, K. and Sunderkötter, C. and Wohlrab, J. and Müller-Ladner, U. and Schneider, M. and Vlachoyianopoulos, P. and Vassilopoulos, D. and Drosos, A. and Antonopoulos, A. and Balbir-Gurman, A. and Langevitz, P. and Rosner, I. and Levy, Y. and Bombardieri, S. and Ferraccioli, G. and Mazzuca, S. and Grassi, W. and Lunardi, C. and Airó, P. and Riccieri, V. and Voskuyl, A.E. and Schuerwegh, A. and Santos, L. and Rodrigues, A.C. and Grilo, A. and Amaral, M.C. and Román Ivorra, J.A. and Castellvi, I. and Spertini, F. and Müller, R. and Oksel, F. and Turkcapar, N. and Herrick, A. and Denton, C. and McHugh, N. and Chattopadhyay, C. and Hall, F. and Buch, M. and on behalf of the CAP Study Investigators",
    journal = "Arthritis and Rheumatology",
    year = "2016",
    volume = "68",
    number = "10",
    pages = "2527-2539",
    publisher = "John Wiley and Sons Inc",
    issn = "2326-5191, 2326-5205",
    doi = "10.1002/art.39718",
    keywords = "adult;  area under the curve;  Article;  bootstrapping;  capillaroscopy;  confidence interval;  controlled study;  demography;  female;  finger;  finger ulcer;  follow up;  human;  major clinical study;  male;  multivariate logistic regression analysis;  priority journal;  receiver operating characteristic;  risk factor;  systemic sclerosis;  univariate analysis;  videocapillaroscopy;  aged;  angioscopy;  clinical trial;  cohort analysis;  complication;  diagnostic imaging;  finger;  limited scleroderma;  middle aged;  multicenter study;  pathophysiology;  Peripheral Vascular Diseases;  prospective study;  risk factor;  skin ulcer;  systemic sclerosis, Adult;  Aged;  Cohort Studies;  Female;  Fingers;  Humans;  Male;  Microscopic Angioscopy;  Middle Aged;  Peripheral Vascular Diseases;  Prospective Studies;  Risk Factors;  ROC Curve;  Scleroderma, Limited;  Scleroderma, Systemic;  Skin Ulcer",
    abstract = "Objective: To identify nailfold videocapillaroscopic features and other clinical risk factors for new digital ulcers (DUs) during a 6-month period in patients with systemic sclerosis (SSc). Methods: In this multicenter, prospective, observational cohort study, the videoCAPillaroscopy (CAP) study, we evaluated 623 patients with SSc from 59 centers (14 countries). Patients were stratified into 2 groups: a DU history group and a no DU history group. At enrollment, patients underwent detailed nailfold videocapillaroscopic evaluation and assessment of demographic characteristics, DU status, and clinical and SSc characteristics. Risk factors for developing new DUs were assessed using univariable and multivariable logistic regression (MLR) analyses. Results: Of the 468 patients in the DU history group (mean ± SD age 54.0 ± 13.7 years), 79.5% were female, 59.8% had limited cutaneous SSc, and 22% developed a new DU during follow-up. The strongest risk factors for new DUs identified by MLR in the DU history group included the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs (categorized as 0, 1, 2, or ≥3), and the presence of critical digital ischemia. The receiver operating characteristic (ROC) of the area under the curve (AUC) of the final MLR model was 0.738 (95% confidence interval [95% CI] 0.681–0.795). Internal validation through bootstrap generated a ROC AUC of 0.633 (95% CI 0.510–0.756). Conclusion: This international prospective study, which included detailed nailfold videocapillaroscopic evaluation and extensive clinical characterization of patients with SSc, identified the mean number of capillaries per millimeter in the middle finger of the dominant hand, the number of DUs at enrollment, and the presence of critical digital ischemia at enrollment as risk factors for the development of new DUs. © 2016, American College of Rheumatology"
}