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

Background: In systemic sclerosis interstitial lung disease (ILD) is the leading cause of mortality [1]. An important unmet clinical need is the to identify patients at risk to develop ILD early, in order to implement personalized monitoring strategies. Although no predictive algorithm is yet available in clinical care, nailfold capillaroscopy is emerging as a promising candidate biomarker to predict the onset of ILD [2]. Objectives: The objective of this study was to evaluate the association between transitions in nailfold capillaroscopy patterns and incident ILD. 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. Conclusion: In conclusion progression towards a more severe nailfold capillaroscopic pattern is associated with a higher risk to develop ILD, necessitating longitudinal nailfold capillaroscopic assessments to identify patients at risk in the early disease stage. REFERENCES: [1] Elhai M et al., Ann Rheum Dis. 2017;76(11):1897-905. [2] Smith V et al., Autoimmun Rev. 2020;19(9):102619. Acknowledgements: NIL. Disclosure of Interests: Arthiha Velauthapillai: None declared, C.H.M. van den Ende: None declared, Madelon Vonk Boehringer Ingelheim, GSK, Janssen, MSD, Novartis, Boehringer Ingelheim, Janssen, Unrestricted research grants from Boehringer Ingelheim, Ferrer and Galapagos. DOI: 10.1136/annrheumdis-2024-eular.2773 Keywords: Prognostic factors, Lungs Citation: , volume 83, supplement 1, year 2024, page 1044Session: Systemic sclerosis (Poster View)

Prognostic factors, Lungs