NAILFOLD CAPILLARY ABNORMALITY AND PULMONARY-HYPERTENSION IN SYSTEMIC-SCLEROSIS

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.