Does nailfold capillaroscopy help predict future outcomes in systemic sclerosis? A systematic literature review.

摘要: Abstract Background Nailfold capillaroscopy (NC) is an important diagnostic tool in systemic sclerosis (SSc). Confirmation of NC as a prognostic factor could facilitate earlier intervention and slow disease progression SSc. We undertook systematic literature review to evaluate the value predicting SSc progression. Methods Standardised searches EMBASE MEDLINE were undertaken identify longitudinal studies adult subjects with reporting for any aspect and/or survival. Non-English, non-original research, animal studies, non-adult non-full length reports excluded from analysis (PROSPERO 2017:CRD42017071719). Wide heterogeneity study design, measurement outcomes necessitated qualitative data synthesis. The “QUality In Prognosis Studies” (QUIPS) risk-of-bias was used assess quality. Study selection, extraction assessment each independently by 2 reviewers consensus reached where necessary. Results Of 942 retrieved articles, 18 fulfilled inclusion criteria. majority (17/18, 94%) reported positive associations between baseline appearances (using variety qualitative, semi-quantitative quantitative endpoints) clinical including digital ulcer (DU) occurrence/healing, survival, domains Medsger severity scale), calcinosis, skin progression, pulmonary arterial hypertension (PAH), composite “cardiovascular events”. Application QUIPS identified moderate-high risk potential bias 6/18 participation, 3/18 attrition, 10/18 measurement, 5/18 outcome 13/18 confounders statistical analyses. quality limited strength conclusions drawn these studies. most source across insufficient adjustment confounders; such existing DU evaluating future occurrence. Recent work suggests evolution predictor Conclusions High levels relating confounding make it difficult draw regarding role There strong evidence supporting association abnormalities (particularly capillary loss) vascular manifestations DU, calcinosis PAH). Evolution may represent more which have implications use routine management