The role of nailfold capillary dropout on mortality in systemic sclerosis

Joanna Tieu, Paul Hakendorf, Richard Woodman, Karen Patterson, Jenny Walker, Peter Roberts-Thomson

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Semi-quantitative wide-field nailfold capillaroscopy (NFC) is a simple technique with proven utility in the early diagnosis of systemic sclerosis (SSc). Its role in prognosis, however, remains uncertain. 

Aim: To investigate the possible utility of NFC in predicting survival. 

Methods: Patients with SSc listed on the South Australian Scleroderma Register (SASR) with prior NFC performed at Flinders Medical Centre from 1991 to 2015 were included in this study. Baseline demographic data, diagnosis, scleroderma antibody status and mortality status were also collected for each patient. 

Results: The cohort consisted of 99 patients with limited cutaneous SSc, 30 patients with diffuse cutaneous SSc and 23 with an overlap scleroderma syndrome. Fifty-six patients died during the period of study (censured end June 2015). Patients with diffuse scleroderma had significantly greater capillary dropout compared with limited and overlap scleroderma (P < 0.001). In univariate analysis, both capillary dropout scores (log-rank χ2 = 8.75, P = 0.003) and antibody status (log-rank χ2 = 13.94, P = 0.003) were associated with mortality. ANOVA showed a significant association between antibody status and capillary dropout (P < 0.001). In Cox regression, adjustment for capillary dropout attenuated the impact of autoantibody group on survival. 

Conclusions: Nailfold capillary dropout was significantly associated with mortality and the severity of dropout attenuates survival dictated by antibody status. Together these observations support the hypothesis that capillary dropout is on the causal pathway between induction of scleroderma associated autoantibodies and mortality.

Original languageEnglish
Pages (from-to)517-523
Number of pages7
JournalInternal Medicine Journal
Issue number5
Early online date24 Jan 2018
Publication statusPublished - May 2018


  • actuarial survival
  • nailfold capillaroscopy
  • nailfold capillary dropout
  • prognosis
  • scleroderma
  • systemic sclerosis


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