TOPLINE:

At diagnosis, nailfold capillaroscopy findings — especially avascular areas — were independent predictors of major cardiovascular events and mortality in patients with systemic sclerosis (SSc), with avascular areas associated with more than a twofold increase in the risk for major cardiovascular events and mortality.

METHODOLOGY:

• Researchers conducted a retrospective, observational, multicenter study of 360 patients diagnosed with SSc (mean age at diagnosis, 63 years; 88.3% women) to assess the predictive value of nailfold capillaroscopy findings for major cardiovascular events and mortality.
• Participants underwent nailfold capillaroscopy within 1 month of diagnosis, with examinations performed by trained rheumatologists using standardized protocols.
• Data on demographics, major SSc manifestations, cardiovascular risk factors and prior cardiovascular events, inflammatory markers and autoantibodies, and clinical outcomes (including the date and classified cause of death, occurrence and type of major cardiovascular events, and acute pulmonary edema) were extracted from hospital records.
• Analysis included the assessment of specific microvascular abnormalities, including giant capillaries, microhemorrhages, and avascular areas, with patients followed up for a median of 11.7 years to track major cardiovascular events and mortality outcomes.

TAKEAWAY:

• At baseline, 88% of patients presented with scleroderma nailfold capillaroscopy patterns, with 33.05% showing an early pattern, 32.5% an active pattern, and 22.5% a late pattern; giant capillaries were observed in 75.28%, microhemorrhages in 54.17%, and avascular areas in 38.6% of patients.
• Independent predictors of major cardiovascular events included diabetes (adjusted hazard ratio [aHR], 2.37; P =.031), interstitial lung disease (aHR, 3.16; P < .001), avascular areas (aHR, 2.24; P = .034), and previous major cardiovascular events (aHR, 3.89; P < .001).
• All-cause mortality was independently associated with age (aHR, 1.034; P = .034) and the presence of avascular areas (aHR, 2.088; P = .032) and inversely associated with disease duration (aHR, 0.813; P < .001) and the presence of microhemorrhages (aHR, 0.351; P = .002).
• Overall mortality rate was 21.1%, with 30.9% of deaths attributed to SSc-related complications; among patients who died due to SSc, survival was particularly poor in those with avascular areas.

IN PRACTICE:

“These findings underscore the value of [nailfold capillaroscopy] at diagnosis, particularly avascular areas, as a prognostic tool for risk assessment in SSc patients,” the authors wrote.

SOURCE:

The study was led by Carlos Valera-Ribera, MD, Hospital Universitario Dr Peset in Valencia, Spain. It was published online on October 11, 2025, in Seminars in Arthritis and Rheumatism.

LIMITATIONS:

The retrospective observational design limited the ability to establish causality between nailfold capillaroscopy findings and outcomes. Evaluations were performed by different assessors at two centers, introducing potential interobserver variability. In addition, the mean age at diagnosis (63 years) was higher than in most contemporary SSc cohorts, which may limit the generalizability of the findings.

DISCLOSURES:

The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.