Capillary permeability in fibromyalgia

OBJECTIVE

To examine capillary permeability in fibromyalgia (FMS) we studied the nailfold capillaries of 13 unselected patients with FMS and 9 healthy controls using dynamic fluorescence videomicroscopy.

METHODS

The transcapillary permeability of a 20% solution of sodium fluorescein injected into an antecubital vein was assessed by videodensitometric analysis. The pericapillary and interstitial fluorescent light intensities (FLI) were calculated at different sites on a transverse axis crossing the selected capillary.

RESULTS

Fluorescence videomicroscopy revealed no abnormalities in the pattern of dye distribution around the nailfold capillaries in the patient group. Videodensitometric analysis showed a trend to an increased early transcapillary diffusion in patients with FMS, but the difference was only significant at 3 s from the first appearance of the dye (p < 0.05). From 10 s to 1 min after the dye's appearance, the mean FLI in the patients equalled that of the controls. The patients with FMS showed an earlier but lower FLI peak. Moreover, the FLI were significantly lower in the patients than in the controls from 5 to 30 min after the dye appearance in all of the sites of the densitometric analysis (p < 0.05). Thirty min after the first appearance of the dye, the FLI was reduced by more than 50% in the patient group compared to the controls.

CONCLUSION

Our results indicate that transcapillary permeability and the interstitial persistence of the tracer in FMS are significantly reduced compared to controls. This difference may be caused by the abnormal microvascular dynamics induced by low capillary flow and/or capillary bed hypotension.

Effects of peripheral cold exposure on microvascular dynamics in systemic sclerosis

OBJECTIVE

To determine the influence of cold exposure on microvascular permeability in systemic sclerosis (SSc).

METHODS

Thirteen patients with SSc were studied by dynamic fluorescence videomicroscopy under basal conditions and after exposure to cold.

RESULTS

Exposure to cold caused a significant reduction in the interstitial concentration of sodium fluorescein (P < 0.05 to 0.001).

CONCLUSION

Our findings show that cold exposure has a striking effect on microvascular dynamics in SSc.

Raynaud's phenomenon in rheumatoid arthritis

The prevalence of Raynaud's phenomenon in RA was retrospectively reviewed in 411 consecutive RA patients and in a control group of 919 consecutive outpatients with OA. Raynaud's phenomenon was found in 19 (4.6%) of 411 RA patients and in 52 (5.6%) of 919 patients with OA: its prevalence was 4.3% (13 cases) in RA inpatients and 5.4% (six cases) in RA outpatients. Among the RA patients, the prevalence of Raynaud's phenomenon was 7.5% in men (7% of inpatients, 8.8% of outpatients) and 3.2% in women (3% of inpatients, 3.9% of outpatients) (P = N.S.). Conversely, the prevalence of Raynaud's phenomenon in patients with OA was higher in women (6.5%) than in men (2.9%) (P = 0.045). Our study indicates that the reported association between Raynaud's phenomenon and RA cannot be confirmed on the basis of a retrospective assessment of its prevalence.

Labial capillary microscopy in systemic sclerosis

OBJECTIVES

To investigate whether in vivo capillary microscopy of the lower lip mucosa can be used to assess microvascular disease in systemic sclerosis.

METHODS

Thirteen patients with systemic sclerosis and 11 healthy control subjects were studied by conventional nailfold capillary microscopy and labial capillaroscopy. The following parameters were analysed: loop length; loop width (maximum distance between the arteriolar and venular limbs); loop density (number of capillaries/mm2); venular plexus visibility; megacapillaries; and the architectural arrangement of the capillary network.

RESULTS

A typical 'scleroderma pattern' at the nailfold was observed in 12 of 13 (92%) patients with systemic sclerosis. Labial capillaroscopy showed a different morphological pattern of microangiopathy. A diffuse architectural derangement of the capillary network was the most striking abnormality in 12 (92%) patients. Labial capillaries in the patients with systemic sclerosis were shorter (mean (SD) loop length 133 (32.2) microns) than in healthy controls (211 (48.4) microns) and showed an increased loop width (41.7 (13.1) v 27.6 (5.5) microns in controls. The loop density was 10.5 (4.6) capillaries/mm2 in patients with systemic sclerosis and 9 (1.7) capillaries/mm2 in controls. Labial capillaroscopy in patients with systemic sclerosis did not provide definite evidence of enlarged capillaries or avascular areas, or both, even where such abnormalities were clearly evident at the nailfold.

CONCLUSIONS

This study shows that labial capillary microscopy is a simple, non-invasive technique which allows a careful morphological assessment of the mucosal microcirculation. Labial capillaroscopy in patients with systemic sclerosis showed significant microvascular changes with respect to the controls. The results of labial and nailfold capillaroscopy are not superimposable, even if some common findings, such as architectural derangement, are present.

Ultrasound examination of metacarpophalangeal joints in rheumatoid arthritis

To evaluate the ability of ultrasonography with high frequency transducer (13-MHz) in detecting metacarpophalangeal (MCP) joint abnormalities, 20 patients with rheumatoid arthritis (RA) and a symptomatic involvement of MCP joints were studied. Twenty healthy subjects served as controls. In all RA patients, ultrasonography clearly demonstrated one or more soft tissue and/or bone abnormalities. Sixteen patients (80%) had joint cavity widening because of effusion (1 case), synovial thickening (7 cases), and joint effusion with synovial thickening (8 cases). Loss of definition of the metacarpal articular cartilage was observed in 17 cases (85%). Sixteen (80%) had bone erosions and 9 (45%) showed a definite widening of the flexor tendons sheath. Margin irregularities of the extensor and flexor tendons were respectively visualized in 7 (35%) and in 8 (40%) cases. An extensor tendon rupture was observed in 2 cases (10%). Ultrasound examination by 13-MHz transducer appears to increase the accuracy of MCP joints evaluation in RA with respect to conventional radiography. It can be recommended as the first investigation in the assessment of soft tissue involvement in RA patients.

Nailfold capillary permeability in psoriatic arthritis

This study is the first report of the permeability status of nailfold capillaries in psoriatic arthritis (PA). "Traditional" nailfold capillary microscopy and intravital fluorescence videomicroscopy were carried out at the nailfold of 13 patients with PA. Twenty five healthy subjects served as controls for nailfold capillary microscopy, and 15 out of these for fluorescence videomicroscopy. The following parameters were assessed: capillary length, apex width, maximum loop width, maximum limb width, loop density, visibility of subpapillary venular plexus, loop tortuosity, transcapillary diffusion, and interstitial concentration at different sites and times of Na-fluorescein given in intravenous bolus. Morphometric analysis of capillaroscopic findings showed a significant increase of loop length (mean +/- SD: 290.1 +/- 73.5 microns) when compared to healthy controls (223.3 +/- 51.9 microns) (P < 0.02). Transcapillary passage of Na-fluorescein was homogeneous and symmetric both in PA patients and in controls. Mean transcapillary and interstitial diffusion was not significantly enhanced at the nailfold in PA patients. Our data support the view that PA is not characterized by a specific capillaroscopic pattern and/or significant abnormalities of microvascular dynamics at the nailfold.

Treatment of rheumatoid arthritis: our experience

Although an incredible amount of time, work and money has been spent in the evaluation of the relative efficacy of anti-rheumatic drugs, no specific resolutive therapy is currently available for rheumatoid arthritis. In these authors' experience early rheumatoid arthritis should be treated with the most powerful non-steroidal anti-inflammatory drug (indomethacin) and the most tolerated disease modifying anti-rheumatic drug (hydroxychloroquine) available. With respect to hydroxychloroquine, auranofin has a comparable efficacy, but the incidence of side effects is significantly higher than with hydroxychloroquine. Sulphasalazine provides very good results. The enthusiasm for this drug is moderated only by the high frequency of patient drop outs. Corticosteroids should be only used in patients with active disease who do not respond to conventional therapy, and/or those with life-threatening complications (i.e., vasculitis).

Microvascular dynamics at the nailfold in rheumatoid arthritis

Conventional and fluorescence videomicroscopy using Na-fluorescein as tracer was performed in 13 patients with rheumatoid arthritis (RA) and Waaler Rose titers less than 1: 112, 10 patients with titers greater than or equal to 1: 112 and 11 patients with osteoarthritis (OA) (control group). At the nailfold different microvascular diameters, capillary flow pattern, red blood cell velocity and transcapillary diffusion of Na-fluorescein were determined. Mean red blood cell velocity was significantly (p less than 0.02) decreased in patients with RA and high titers (0.23 +/- 0.21 0.21 mm/s) when compared to OA patients (0.59 +/- 0.20 mm/s). Abnormal flow patterns, in 2 cases even a reversal of flow direction, were only observed in RA patients and not in controls. Mean transcapillary and interstitial diffusion of Na-fluorescein was not enhanced at the nailfold in RA-patients. These findings do not exclude increased microvascular permeability in synovial membranes or in RA patients with vasculitis.

HLA-B27 negative ankylosing spondylitis and hidradenitis suppurativa: report of a case

The association between hidradenitis suppurativa and joint involvement is well recognized. We describe a 63-year-old man with a severe HLA-B27 negative ankylosing spondylitis associated with hidradenitis suppurativa. We are not aware of any reports of such an association in the literature.

Interactive image analysis in the rectal mucosa of rheumatoid arthritis

Interactive measurements of 22 quantitative parameters concerning the status and inflammation of the mucosa were taken in the rectal biopsies of patients suffering from Rheumatoid Arthritis, or with mild nonspecific morphological abnormalities (M.N.M.A.) and inflammation of the lamina propria or with Infective Colitis. The results showed that mean and standard deviation values of the rheumatoid patients are generally intermediate between those of control cases and those of M.N.M.A. and Infective Colitis. The variance analysis revealed that significant differences in some of the features exist between the four groups. Stepwise discriminant analysis helped in identifying three parameters that contributed significantly to discriminating 96.30% of the cases: Mucin area/Mucosal area; Number of inflammatory cells in the lower half/Number of inflammatory cells in the upper half of the mucosal thickness; Number of Granulocytes/mm2 of the lamina propria. Of the 27 cases included in the study, only one belonging to the control group was allocated incorrectly by the computer to the Rheumatoid Arthritis category. High correlation coefficients were observed between some of the morphometric, serological and clinical data in the rheumatoid patients. The highest values were between Number of Mononuclear cells/mm2 of lamina propria and C-Reactive Protein (+0.920) as well as between Mucin area/Mucosal area and serum IgM level (-0.950).

Nailfold computed videomicroscopy in morpho-functional assessment of diabetic microangiopathy

Although careful measurement of the size of capillary loops is mandatory in the evaluation of diabetic microangiopathy, no current technique allows rapid and careful morphometric analysis of capillaroscopic findings. In an attempt to solve this problem, assembling readily available instruments, the authors have set up an original apparatus for computed videomicroscopy. The apparatus ensures detailed morphological assessment of single loops at high magnification. Each single frame stored on videocassettes can be digitalized for morphometric analysis, saved on floppy disk or printed by means of a graphic printer.

[Periungual capillary microscopy in patients with chronic polyarthritis and psoriasis arthropathica]

The aim of this study was to investigate the prevalence of nail bed capillary abnormalities in rheumatoid arthritis and psoriatic arthritis. In 10 per cent of rheumatoid patients the morphological pattern of the nail bed capillaries of the ten fingers was remarkably variable. Long capillaries and a clearly visible subpapillary plexus were the most prominent findings in these patients. The only significant finding observed in patients with psoriatic arthritis was a high subpapillary plexus visibility. Avascular areas and giant loops (typical of scleroderma) were not found in either disorder.

Ultrastructural aspects of nailfold capillaries in a case of eosinophilic fasciitis

An ultrastructural study was made on the nailfold capillaries in an 18-year-old female with eosinophilic fasciitis. Scleroderma-like capillaroscopic lesions were visible at the sites where biopsy was performed. Light microscopy revealed ectasic capillaries at the apex of dermal papillae. Aspects of thickening and duplication of the epidermal basement membrane as well as an activation of endothelial cells were visualized at the ultrastructural level. These cells contained many virus-like tubulo-reticular inclusions, associated with cisternae of endoplasmic reticulum. Aspects of degeneration of nerve fibres and Schwann cells were also present. Large, homogeneously electron-dense deposits could be seen in the basement membrane at the dermo-epidermal junction. This study not only confirms previous observations on the microangiopathy in eosinophilic fasciitis, but also documents two new aspects: electron-dense deposits at the dermo-epidermal junction and tubulo-reticular inclusions within endothelial cells.

The chiromorphoergometry and the chirophotogrammetry

The authors suggest a suitable method for "measuring" morpho-functional involvement of hands (and wrists). This method analyzes four tests: three postural tests and a photogrammetric test. The three positions are: - "Praying hands" (fig. 1) - "Dorsum of the hands opposed" (fig. 2) - "Phalanges opposed (by their dorsum)" (fig. 3) These positions (1-2-3) define three angles alpha 1, alpha 2, alpha 3. The corresponding indices I1, I2, I3 are synthetized by the following mathematical formula: Ii = 1 - alpha i/90 Patients, in the photogrammetric (or surface) test, lean their hands on a Chigot's plantiscope. The illuminated area provides the fourth index expressed by this formula: I4 = 2,5 Sc/St - 0,25 It is possible to calculate a general index It with the following formula: (formula; see text) Angles and surfaces are documented photographically. The method may be very helpful in evaluating the clinical course and therapy of rheumatoid arthritis.

HLA and psoriasis (with or without arthropathy)

30 probands affected by psoriasis, with or without arthropathy, and their relatives were typed for HLA-A, -B and -C antigens. Association of HLA-B16 and HLA-B17 with psoriasis was confirmed. One third of probands was without any known HLA-A, -B, -C marker. Considering probands with at least one HLA-B marker, we found that 50% of their sibs carrying marker is affected and the remaining 50% is healthy. To explain the weak association observed, an attempt to propose a model is made: such a model postulate a gene interaction between the HLA marker gene and an hypothetic "Ps (Psoriasis susceptibility) gene". The model, described in detail in this work, tries to explain why a large part (1/3) of probands is affected even if they do not carry any HLA marker and why 50% of marker positive sibs of marker positive probands are healthy.