T. Ohtsuka et al., NAILFOLD CAPILLARY ABNORMALITY AND PULMONARY-HYPERTENSION IN SYSTEMIC-SCLEROSIS, International journal of dermatology, 36(2), 1997, pp. 116-122
Background Patients with systemic sclerosis (SSC) show a capillary abn
ormality of nailfolds with controversial correlation with organ involv
ement. Our purpose was to study the correlation between this nailfold
capillary abnormality and pulmonary hypertension in patients with SSC.
Methods We studied the nailfold capillaries, using capillary microsco
py, and the pulmonary arterial pressure, using right-heart catheteriza
tion, in 44 patients with SSC. Canonical discriminant analysis was use
d to define the capillary abnormality in patients with SSC, which was
then compared with that of 40 normal controls. The correlations betwee
n the patterns of nailfold capillaries and the cardiopulmonary finding
s, including the pulmonary arterial pressure, were examined using Fish
er's test. Results Thirty-two of 44 patients with SSC could be differe
ntiated from normal controls by our definition of the SSC pattern. The
SSC pattern correlated significantly with elevated pulmonary vascular
resistance, as well as with pulmonary fibrosis, electrocardiographic
abnormalities, decreased vital capacity, and decreased diffusing capac
ity for carbon monoxide. All SSC patients with pulmonary hypertension
showed this SSC pattern. In patients with elevated pulmonary arterial
pressure, capillary microscopy and diffusion capacity for carbon monox
ide (DCCM) showed the highest rate of abnormalities. A limited-type SS
C significantly correlated with DCCM and with anticentromere antibody,
and the diffuse-type SSC with pulmonary fibrosis and anti-sci-70 anti
body. Conclusion Our data suggest that in patients with SSC, nailfold
capillary abnormalities correlate with pulmonary arterial hypertension
as well as with clinical and laboratory findings indicating pulmonary
hypertension.