POS0822 ASSOCIATION BETWEEN NAILFOLD CAPILLAROSCOPIC PATTERN AND INCIDENT INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS: A EUSTAR DATABASE ANALYSIS (2024)

Methods: Patient data from the EUSTAR database were collected of those patients who had least one ILD-free visit with a documented scleroderma pattern at nailfold capillaroscopy, spanning up to 5 years. The baseline for analysis was established as the first recorded ILD-free visit with a documented scleroderma pattern. Only data of patients fulfilling the following key criteria were included in the analysis: age ≥ 18 years, fulfilling ACR-EULAR classification criteria, disease duration from first non-Raynaud phenomenon ≤ 5 years, HRCT confirmed absence of ILD at baseline, at least one follow-up nailfold capillaroscopy, and a minimal follow-up duration of1 year.

Mixed logistic regression models were constructed to assess the association between annual risk of ILD and nailfold capillaroscopy pattern. The model was corrected for a priori defined confounders, namely gender, diffuse cutaneous subtype, Caucasian ethnicity, presence of anti-topoisomerase-I antibodies, presence of anti-RNA polymerase III antibodies, higher age, forced vital capacity % predicted, and diffusing capacity of the lungs for carbon monoxide % predicted. In addition, the other covariates were assessed for confounding with a change-in-estimation model.

Results: We identified 275 patients meeting the eligibility criteria, from which 90(33%) patients had an early scleroderma pattern, 135(49%) patients had an active scleroderma pattern, and 50(18%) patients had a late scleroderma pattern. Patients with a more severe nailfold capillaroscopic pattern (i.e. active or late) had an unfavourable disease phenotype (Table 1).

In our cohort, 66(24%) of the patients developed ILD after a mean(SD) follow-up period of 2.2(1.2) years. The mixed regression model corrected for the a priori defined confounders as well as for modified Rodnan skin score revealed a rise in the annual risk for incident ILD with worsening severity of nailfold capillaroscopic pattern: OR(95%CI); 3.76(1.99-7.11, p<0.01 (Figure 1). Thus, these results indicate an increased risk for incident ILD after? a transition towards a deteriorating nailfold capillaroscopic pattern, along with a reduced risk for incident ILD when transitioning to an improved nailfold capillaroscopic pattern.

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[2] Smith V et al., Autoimmun Rev. 2020;19(9):102619.