Does nailfold capillaroscopy help predict future outcomes in systemic sclerosis? A systematic literature review

Area of Science:

• Rheumatology
• Dermatology
• Vascular Medicine

Background:

• Nailfold capillaroscopy (NC) is a key diagnostic tool for systemic sclerosis (SSc).
• Confirming NC's prognostic value could enable earlier intervention and slow SSc progression.
• This systematic review evaluated the prognostic significance of NC in predicting SSc disease progression.

Purpose of the Study:

• To systematically review and evaluate the prognostic value of nailfold capillaroscopy (NC) in predicting disease progression in systemic sclerosis (SSc).

Main Methods:

• A systematic literature search of EMBASE and MEDLINE identified longitudinal studies of adult SSc patients.
• Studies reporting prognostic value of NC for disease progression or survival were included.
• The QUality In Prognosis Studies (QUIPS) tool assessed study quality and risk of bias.

Main Results:

• 18 studies met inclusion criteria, with 94% reporting positive associations between NC findings and clinical outcomes.
• Observed associations included digital ulcer occurrence, survival, disease severity, calcinosis, skin progression, pulmonary arterial hypertension, and cardiovascular events.
• Moderate-to-high risk of bias was identified in most studies, particularly concerning confounders and statistical analysis.

Conclusions:

• Potential biases in study confounding and statistical analysis limit definitive conclusions on NC's prognostic role in SSc.
• Strong evidence links NC abnormalities, especially capillary loss, to SSc disease severity, particularly vascular manifestations.
• NC appearance evolution may be a more critical predictor of SSc progression, impacting future longitudinal assessment and management.