TY - JOUR
TI - Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study
AU - Cutolo, M.
AU - Herrick, A.L.
AU - Distler, O.
AU - Becker, M.O.
AU - Beltran, E.
AU - Carpentier, P.
AU - Ferri, C.
AU - Inanç, M.
AU - Vlachoyiannopoulos, P.
AU - Chadha-Boreham, H.
AU - Cottreel, E.
AU - Pfister, T.
AU - Rosenberg, D.
AU - Torres, J.V.
AU - Smith, V.
AU - Erlacher, L.
AU - Hirschl, M.
AU - Kiener, H.P.
AU - Pilger, E.
AU - Blockmans, D.
AU - Wautrecht, J.-C.
AU - Becvár, R.
AU - Frances, C.
AU - Lok, C.
AU - Sparsa, A.
AU - Hachulla, E.
AU - Quere, I.
AU - Allanore, Y.
AU - Agard, C.
AU - Riemekasten, G.
AU - Hunzelmann, N.
AU - Stücker, M.
AU - Ahmadi-Simab, K.
AU - Sunderkötter, C.
AU - Wohlrab, J.
AU - Müller-Ladner, U.
AU - Schneider, M.
AU - Vlachoyianopoulos, P.
AU - Vassilopoulos, D.
AU - Drosos, A.
AU - Antonopoulos, A.
AU - Balbir-Gurman, A.
AU - Langevitz, P.
AU - Rosner, I.
AU - Levy, Y.
AU - Bombardieri, S.
AU - Ferraccioli, G.
AU - Mazzuca, S.
AU - Grassi, W.
AU - Lunardi, C.
AU - Airó, P.
AU - Riccieri, V.
AU - Voskuyl, A.E.
AU - Schuerwegh, A.
AU - Santos, L.
AU - Rodrigues, A.C.
AU - Grilo, A.
AU - Amaral, M.C.
AU - Román Ivorra, J.A.
AU - Castellvi, I.
AU - Spertini, F.
AU - Müller, R.
AU - Oksel, F.
AU - Turkcapar, N.
AU - Herrick, A.
AU - Denton, C.
AU - McHugh, N.
AU - Chattopadhyay, C.
AU - Hall, F.
AU - Buch, M.
AU - on behalf of the CAP Study Investigators
JO - Arthritis and Rheumatology
PY - 2016
VL - 68
TODO - 10
SP - 2527-2539
PB - John Wiley and Sons Inc
SN - 2326-5191, 2326-5205
TODO - 10.1002/art.39718
TODO - 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
TODO - 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
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