0249: Obesity as a possible confusion factor in the scleroderma pattern

Background/Purpose: The 2023 EULAR criteria for systemic sclerosis reaffirm the diagnostic value of nailfold videocapillaroscopy (NVC), particularly the presence of giant capillaries and capillary loss to detect scleroderma pattern. However, their presence in non-rheumatic patients with cardiovascular risk factors (CVRFs), such as overweight/ obesity (OBE), remains underexplored.

The main objective of the study was to evaluate the existence of differences in capillaroscopic findings, in patients with OBE compared to patients with normal weight.

Methods: Longitudinal unicentric observational study carried out in 2020 and 2025, in which the frequency of pathological findings in capillaroscopy is estimated in subjects without rheumatic disease or Raynaud's phenomenon and compared by presence of OBE (body mass index >26) and normal weight. Exclusion criteria included having Raynaud's phenomenon or any rheumatological disease, as well as having a CVRF other than OBE.The variables collected were: sociodemographic, weight, height and body mass index, cardiovascular complications, autoimmunity, lipid profile, treatments, tortuosities and NVC alterations (ramified capillaries, enlarged capillaries, giant capillaries, haemorrhages and density loss). The NVC was performed again after 5 years, in 2025, to verify evolution.

For the statistics, measures of central tendency and dispersion were used for quantitative variables, and frequencies and percentages for qualitative variables. The outcome variable was OBE yes/no, and the X² test and Fisher’s test were used to compare variables.

Results: 78 subjects were included (78,2% men, mean age 48±13 years), 39 with only obesity as a CVRF and 39 healthy controls without CVRF. The predominant vascular or thrombotic complication was abortion in 15.4% of the subjects, followed by stroke in 2,6% of participants. The presence of tortuosities was observed in 82.1% of the participants, subsequently 44.9% ramified capillaries, 35.9% enlarged capillaries, 33.3% haemorrhages, 28.2% density loss and 26.6% giant capillaries.
A statistically significant association was found between OBE and the presence of all the NVC findings, especially giant capillaries and density loss (p < 0,001).

These OBE patients were classified as having a scleroderma pattern and remained asymptomatic throughout. Five years later, the analytical and capillaroscopic studies were repeated, revealing the same NVC changes, with no development of rheumatologic pathology in any of them.

Conclusion: Scleroderma-pattern capillaroscopic findings may occur in non-rheumatic patients with OBE. These results underscore the importance of clinical context in interpreting NVC findings and suggest a potential overlap between metabolic and autoimmune microvascular damage.