Predicting cardiopulmonary involvement in patients with systemic sclerosis: complementary value of nailfold videocapillaroscopy patterns and disease-specific autoantibodies. (9th December 2016)

• Record Type: Journal Article
• Authors: Markusse, Iris M.; Meijs, Jessica; de Boer, Berber; Bakker, Jaap A.; Schippers, H. Pascal C.; Schouffoer, Anne A.; Ajmone Marsan, Nina; Kroft, Lucia J. M.; Ninaber, Maarten K.; Huizinga, Tom W. J.; de Vries-Bouwstra, Jeska K.
• Is Part Of: Rheumatology. Volume 56:Number 7(2017)
• Page Start: 1081
• Page End: 1088
• Publication Date: 2016-12-09
• Subjects: systemic sclerosis -- autoantibodies -- anti-ENA -- nailfold videocapillaroscopy -- cardiopulmonary involvement -- screening; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/kew402
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective . To evaluate the prevalence of anti–extractable nuclear antigen (anti-ENA) antibodies in Dutch SSc patients and the predictive power of the combination of specific anti-ENA antibodies and nailfold videocapillaroscopy (NVC) patterns to improve identification of patients with high risk for cardiopulmonary involvement. Methods . A total of 287 patients (79%) from the Leiden SSc-Cohort had data available on NVC-pattern (no SSc-specific, early, active, late) and anti-ENA antibodies. Associations between anti-ENA/NVC combinations with cardiopulmonary parameters were explored using logistic regression. Results . Prevalence of ACA was 37%, anti-Scl-70 24%, anti-RNP 9%, anti-RNAPIII 5%, anti-fibrillarin 4%, anti-Pm/Scl 3%, anti-Th/To 0.3% and anti-Ku 1.4%. NVC showed a SSc-specific pattern in 88%: 10% early, 42% active and 36% late. The prevalence of different NVC patterns was equally distributed among specific anti-ENA antibodies, except for the absence of early pattern in anti-RNP positive patients. Fifty-one percent had interstitial lung disease (ILD), 59% had decreased diffusion capacity for carbon monoxide and 16% systolic pulmonary artery pressure >35 mmHg (sPAP↑). Regardless of ENA-subtype, NVC-pattern showed a stable association with presence of ILD or sPAP↑. For ILD, the odds ratios (ORs) were 1.3–1.4 ( P < 0.05 for analyses with anti-RNAPIII, anti-RNP). For diffusion capacity for carbon monoxide, the OR was 1.5 ( P < 0.05 for analyses with ACA, anti-Scl-70, anti-RNAPIII, anti-RNP). For sPAP↑, the ORs were 2.2–2.4 ( P < 0.05 for analyses with anti-RNAPIII, anti-RNP). Conclusion . In Dutch SSc patients, all SSc-specific auto-antibodies were found, with ACA and anti-Scl-70 being the most prevalent. Strikingly, the association between NVC-pattern and heart/lung involvement was independent of specific anti-ENA antibodies, which might indicate microangiopathy is an important cause of organ involvement.