Nailfold capillaroscopic changes in Egyptian patients with psoriatic arthritis in comparison to rheumatoid arthritis

Nailfold Capillaroscopy Findings in Patients With Psoriasis Vulgaris and Different Domains of Psoriatic Arthritis

Background

Psoriasis is a chronic autoimmune disease with longtime activity and multisystem affection. Nailfold capillaroscopy (NC) is a simple noninvasive microscopic tool useful for identification of nailfold microvasculopathy.

Objective

The present study aimed to compare NC findings in patients with psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) with different clinical domains.

Methods

The present cross-sectional study included 200 psoriasis patients classified into five 40-patient groups: group I (GI) included PsA patients with predominant peripheral arthritis; group II (GII) included PsA patients with predominant peripheral arthritis and dactylitis and/or enthesitis; group III (GIII) included PsA patients with predominant axial affection; group IV (GIV) patients included PsA patients with predominant axial affection and dactylitis and/or enthesitis and group V (GV) included patients with PsV. In addition, there were 40 age and sex-matched healthy controls (GVI).

Results

The studied patients had capillary density of 6.7 ± 3.5/mm with 90 patients (45.0 %) having reduced capillary density. GI-GIV patients had significantly lower capillary density and higher frequency of patients with reduced capillary density as compared to GV patients. The reported capillary dimension in the studied patients is 15.7 ± 7.9 μm and 55 patients (27.5 %) had large/giant capillaries. Patients in GV had significantly lower capillary dimension in comparison to GI-GIV patients. There were 64 patients (32.0 %) with abnormal capillary morphology and 47 patients (23.5 %) with capillary hemorrhages.

Conclusions

PsA patients of all domains have lower capillary density and larger capillary dimensions as compared to PsV patients.

Nailfold capillaroscopy as diagnostic test in patients with psoriasis and psoriatic arthritis: A systematic review

Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable, non-invasive procedure to assess skin microcirculation. This systematic review investigates NC as diagnostic tool for PsO and PsA, including correlations between NC outcome measures to clinical and laboratory outcome measures. This systematic review was built on the PICO and PRISMA guidelines. In total 22 relevant studies were found Searching in the Web of Science, PubMed and Embase, latest update June 13th, 2022. The following NC outcome measures are found to be significantly more prevalent in PsO patients than healthy controls: reduced density, reduced length and more abnormal morphology. Likewise, in PsA patients, reduced density, more abnormal morphology, more microhaemorrhages and fewer hairpin shapes are found to be significantly more prevalent. Results were non-conclusive in terms of disease activity and duration with NC findings. Random-effects meta-analysis showed a significant reduction of density in PsO patients compared to healthy controls (studies: 6, n = 249; SMD = -0.91; 95 % CI [-1.41, -0.40], p = 0.0058, heterogeneity I²=74 %, AUC = 0.740) and in PsA patients compared to healthy controls (studies: 5, n = 130; SMD = -1.22; 95 % CI [-2.38, -0.06], p = 0.0432, heterogeneity I²=89 %, AUC = 0.806). No NC outcome measures were overall conclusive in differentiating PsO from PsA. Considering the conflicting results and small sample sizes further large-scale research on the identification of capillaroscopic changes in PsO and PsA and correlations with standardised clinical and laboratory outcome measures are necessary.