Combination of Capillaroscopic and Ultrasonographic Evaluations in Systemic Sclerosis: Results of a Cross‐Sectional Study

Objective

To compare microvascular damages on nailfold capillaroscopy (NFC) with macrovascular manifestations evaluated by hand power Doppler ultrasonography (PDUS) in systemic sclerosis (SSc) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers, acroosteolysis, and calcinosis.

Methods

NFC, hand radiographs, and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were performed blinded for the results of radiographs and NFC.

Results

UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NFC (odds ratio [OR] 4.04 [95% confidence interval (95% CI) 1.23–13.29]; P < 0.05, and OR 3.38 [95% CI 1.03–11.05]; P < 0.05, respectively). Digital ulcer history was associated with UAO (OR 10.71 [95% CI 3.36–34.13]; P < 0.0001), pathologic FPBF (OR 7.67 [95% CI 2.52–23.28]; P < 0.0001), late NFC pattern (OR 6.33 [95% CI 2.03–19.68]; P = 0.001), and severe capillary loss (OR 8.52 [95% CI 2.15–33.78]; P = 0.001). Acroosteolysis was also associated with UAO (OR 15.83 [95% CI 3.95–63.54]; P < 0.0001), pathologic FPBF (OR 5.52 [95% CI 1.71–17.90]; P = 0.003), late NFC pattern (OR 6.86 [95% CI 2.18–21.53]; P = 0.001), and severe capillary loss (OR 7.20 [95% CI 2.16–24.02]; P = 0.001). Calcinosis on radiographs was associated with late NFC pattern (OR 5.41 [95% CI 1.82–16.12]; P = 0.002), severe capillary loss (OR 12.69 [95% CI 3.14–51.26]; P < 0.0001), and UAO (OR 3.19 [95% CI 1.14–8.92]; P = 0.025). Combination of UAO and severe capillary loss in the same patient was especially associated with digital ulcer history (OR 18.60 [95% CI 2.24–154.34]; P = 0.001) and acroosteolysis (OR 10.83 [95% CI 2.56–45.88]; P = 0.001).

Conclusion

Microvascular damages evaluated by NFC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease.

     

Measuring quality of life in older people: Reliability and validity of WHOQOL‐OLD

Objectives: The World Health Organization (WHO) recently developed a generic Quality of Life (QOL) measure, the WHOQOL‐OLD, specifically for use with older adults. This pilot study aimed to test the psychometric properties of the new measure to determine its suitability for evaluating outcomes of healthy ageing interventions. Methods: A random sample of 100 participants aged 65 years and older, selected from a database of community research volunteers, was invited to complete a mailed questionnaire administered at two time points. The questionnaire included the WHOQOL‐OLD, a generic health‐related QOL measure, the SF‐12, as well as psychological and physical well‐being measures and demographic data. Results and conclusion: Overall, the WHOQOL‐OLD demonstrated good performance on tests of reliability and validity and had features that made it a more suitable outcome measure of QOL in older people compared with the frequently used measure, the SF‐12.