Nailfold capillaroscopy as a predictor of major cardiovascular events and mortality in systemic sclerosis

To assess the predictive value of nailfold capillaroscopy (NFC) findings for major cardiovascular events (MCEs) and mortality in systemic sclerosis (SSc) patients, in comparison with other clinical variables.

This retrospective, observational study included 360 SSc patients diagnosed according to the 2013 ACR/EULAR criteria. All patients underwent NFC within one month of diagnosis.

At baseline, 88% of patients presented a scleroderma NFC pattern (33.05% early, 32.5% active, and 22.5% late). Giant capillaries were found in 75.28%, microhaemorrhages in 54.17%, and avascular areas in 38.6% of patients. During a median follow-up of 11.7 years, 64 patients (17.8%) experienced a MCE. The overall mortality rate was 21.1% (76 patients), with 30.9% of deaths attributed to SSc-related complications, 29.4% to MCEs, and 39.7% to other causes. In multivariable analyses, independent predictors of MCEs were diabetes mellitus (HR 2.37, p = 0.031), interstitial lung disease (HR 3.16, p < 0.001), avascular areas on baseline NFC (HR 2.24, p = 0.034), and previous MCE (HR 3.89, p < 0.001). Whereas, microhaemorrhages showed protective trend (HR 0.55, p = 0.053). Independent predictors of all-cause mortality were age (HR 1.03, p = 0.039), disease duration (HR 0.81, p < 0.001), and avascular areas (HR 2.09, p = 0.032), while microhaemorrhages were protective (HR 0.35, p = 0.002) For SSc-related mortality rates, avascular areas associated with a poorer survival rate (log-rank p-value <0.001) and microhaemorrhages with a better survival (log rank p-value = 0.01).

Avascular areas in baseline NFC are strong predictors of MCEs and mortality in SSc, whereas microhaemorrhages have a lower risk. Integrating NFC into clinical practice as a prognostic tool may improve risk stratification.