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Schonenberg-Meinema D, Cutolo M, Smith V. Capillaroscopy in the daily clinic of the pediatric rheumatologist. Best Pract Res Clin Rheumatol 2024:101978. [PMID: 39034217 DOI: 10.1016/j.berh.2024.101978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/02/2024] [Accepted: 07/17/2024] [Indexed: 07/23/2024]
Abstract
In the last decade, nailfold capillaroscopy is finding its way to the daily clinic of (pediatric) rheumatologist. This review will provide the necessary knowledge for the clinician performing this easy and non-invasive examination in children. In the first part, background information on type of capillaroscopy device and standardized (internationally validated) interpretations for the different capillary variables compared to healthy pediatric controls will be provided. The second part focusses on capillary changes that are observed in Raynaud's phenomenon with follow-up recommendations. This part will also cover capillaroscopy findings in juvenile systemic sclerosis, childhood-onset systemic lupus erythematosus, juvenile dermatomyositis and -mixed connective tissue disease, as well as correlations with disease severity. Lastly, a research agenda shows the current gaps we have in knowledge in this niche of nailfold capillaroscopy in pediatric connective tissue diseases.
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Affiliation(s)
- D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands.
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genova, Italy
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, Belgium; Faculty of Internal Medicine, Ghent University, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
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Mostmans Y, Maurer M, Richert B, Smith V, Melsens K, De Maertelaer V, Saidi I, Corazza F, Michel O. Chronic spontaneous urticaria: Evidence of systemic microcirculatory changes. Clin Transl Allergy 2024; 14:e12335. [PMID: 38282194 PMCID: PMC10821744 DOI: 10.1002/clt2.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/24/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a chronic inflammatory skin disease where activation of endothelial cells (ECs) at sites of skin lesions leads to increased blood flow, leakage of fluid into the skin, cellular infiltration, and vascular remodeling. To understand the disease duration and the sometimes vague systemic symptoms accompanying flares, the objective of this study was to examine if CSU comes with systemic vascular changes at the microcirculatory level. METHODS We investigated CSU patients (n = 49) and healthy controls (HCs, n = 44) for microcirculatory differences by nailfold videocapillaroscopy (NVC) and for blood levels of the soluble EC biomarkers serum vascular endothelial growth factor (VEGF), soluble E-selectin, and stem cell factor (SCF). Patients were also assessed for clinical characteristics, disease activity, and markers of autoimmune CSU (aiCSU). RESULTS CSU patients had significantly lower capillary density, more capillary malformations, and more irregular capillary dilations than HCs on NVC. Serum levels of VEGF, soluble E selectin and SCF were similar in CSU patients and HCs. CSU patients with higher VEGF levels had significantly more abnormal capillaries. Patients with markers of aiCSU, that is, low IgE levels or increased anti-TPO levels, had significantly more capillaries and less capillary dilations than those without. CONCLUSION Our results suggest that CSU comes with systemic microcirculatory changes, which may be driven, in part, by VEGF.
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Affiliation(s)
- Yora Mostmans
- Department of Immunology‐AllergologyCHU BrugmannUniversité Libre de Bruxelles (ULB)LakenBelgium
- Department of DermatologyCHU BrugmannULBLakenBelgium
| | - Marcus Maurer
- Institute of AllergologyCharité–Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMPAllergology and ImmunologyBerlinGermany
| | | | - Vanessa Smith
- Department of Internal MedicineGhent UniversityGhentBelgium
- Department of RheumatologyGhent University HospitalGhentBelgium
- Unit for Molecular Immunology and InflammationVIB Inflammation Research Center (IRC)GhentBelgium
| | - Karin Melsens
- Department of Internal MedicineGhent UniversityGhentBelgium
- Department of RheumatologyGhent University HospitalGhentBelgium
- Unit for Molecular Immunology and InflammationVIB Inflammation Research Center (IRC)GhentBelgium
- Department of RheumatologyVrije Universiteit Brussel (VUB)Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
| | | | - Ines Saidi
- Department of DermatologyCHU BrugmannULBLakenBelgium
| | - Francis Corazza
- Department of ImmunologyLaboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussels (LHUB‐ULB)BrusselsBelgium
| | - Olivier Michel
- Department of Immunology‐AllergologyCHU BrugmannUniversité Libre de Bruxelles (ULB)LakenBelgium
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Kouwenberg CV, Spierings J, de Groot EL, de Boer JH, Kalinina Ayuso V. Involvement of the systemic microcirculation in pediatric uveitis. Pediatr Rheumatol Online J 2023; 21:109. [PMID: 37784087 PMCID: PMC10544362 DOI: 10.1186/s12969-023-00896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Pediatric uveitis is a severe inflammatory ocular condition that can lead to sight-threatening complications and can negatively impact quality of life. The retinal microcirculation is often affected in intermediate uveitis and panuveitis. Here, we examined the extraocular (i.e., systemic) microcirculation in pediatric uveitis cases and healthy controls using nailfold capillaroscopy (NFC). METHODS We performed NFC in 119 children with noninfectious uveitis and 25 healthy pediatric controls, and assessed the following parameters: capillary density (number of capillaries/mm), dilated capillaries (apex > 20 µm), avascular area, the presence of microhemorrhages, and capillary morphology. Differences in NFC parameters between cases and controls were calculated using regression analysis after adjusting for age and sex. RESULTS The mean (± SD) age of the patient group was 13.7 (± 3) years, with 56% females; 46%, 18%, and 36% of cases presented as anterior uveitis, intermediate uveitis, and panuveitis, respectively, with an overall mean disease duration of 4.7 (± 4.0) years. Compared to the control group, the pediatric uveitis cases had a significantly higher number of dilated capillaries/mm and a higher prevalence of ramified capillaries. Moreover, compared to the control group the intermediate uveitis cases had a significantly higher number of dilated capillaries, whereas the anterior uveitis cases had a lower capillary density and a higher prevalence of ramified capillaries. CONCLUSIONS Children with uveitis without systemic disease can present with changes in systemic microcirculation. These changes vary amongst the subtypes of uveitis.
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Affiliation(s)
- Carlyn V Kouwenberg
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands.
| | - Julia Spierings
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Evianne L de Groot
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Joke H de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
| | - Viera Kalinina Ayuso
- Department of Ophthalmology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands
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Di Maggio G, Confalonieri P, Salton F, Trotta L, Ruggero L, Kodric M, Geri P, Hughes M, Bellan M, Gilio M, Lerda S, Baratella E, Confalonieri M, Mondini L, Ruaro B. Biomarkers in Systemic Sclerosis: An Overview. Curr Issues Mol Biol 2023; 45:7775-7802. [PMID: 37886934 PMCID: PMC10604992 DOI: 10.3390/cimb45100490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by significant fibrosis of the skin and internal organs, with the main involvement of the lungs, kidneys, heart, esophagus, and intestines. SSc is also characterized by macro- and microvascular damage with reduced peripheral blood perfusion. Several studies have reported more than 240 pathways and numerous dysregulation proteins, giving insight into how the field of biomarkers in SSc is still extremely complex and evolving. Antinuclear antibodies (ANA) are present in more than 90% of SSc patients, and anti-centromere and anti-topoisomerase I antibodies are considered classic biomarkers with precise clinical features. Recent studies have reported that trans-forming growth factor β (TGF-β) plays a central role in the fibrotic process. In addition, interferon regulatory factor 5 (IRF5), interleukin receptor-associated kinase-1 (IRAK-1), connective tissue growth factor (CTGF), transducer and activator of transcription signal 4 (STAT4), pyrin-containing domain 1 (NLRP1), as well as genetic factors, including DRB1 alleles, are implicated in SSc damage. Several interleukins (e.g., IL-1, IL-6, IL-10, IL-17, IL-22, and IL-35) and chemokines (e.g., CCL 2, 5, 23, and CXC 9, 10, 16) are elevated in SSc. While adiponectin and maresin 1 are reduced in patients with SSc, biomarkers are important in research but will be increasingly so in the diagnosis and therapeutic approach to SSc. This review aims to present and highlight the various biomarker molecules, pathways, and receptors involved in the pathology of SSc.
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Affiliation(s)
- Giuseppe Di Maggio
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Pietro Geri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Medicine, Azienda Ospedaliero–Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Michele Gilio
- Infectious Disease Unit, San Carlo Hospital, 85100 Potenza, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
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Fukasawa T, Toyama S, Enomoto A, Yoshizaki-Ogawa A, Norimatsu Y, Tateishi S, Kanda H, Miyagawa K, Sato S, Yoshizaki A. Utility of nailfold capillary assessment for predicting psoriatic arthritis based on a prospective observational cohort study. Rheumatology (Oxford) 2023; 62:2418-2425. [PMID: 36440919 DOI: 10.1093/rheumatology/keac664] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/19/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES PsA is one of the most serious comorbidities associated with psoriasis. While the early intervention in PsA is demanded, risk factors of PsA development are not well-known. This is the first prospective study to evaluate the clinical significance of nailfold capillary (NFC) changes in patients with psoriasis. METHODS We conducted a prospective cohort study in a population of 449 psoriasis patients who had not been treated with systemic therapy or topical finger therapy. NFCs were observed by dermoscopy and capillaroscopy, and the correlation of NFC abnormalities, including nailfold bleeding (NFB) and enlarged capillaries, with the prevalence of PsA, incidence of new PsA, and serum levels of TNF-a, IL-17A and IL-23 were analysed. RESULTS Detailed examination at the time of inclusion revealed that of 449 patients, 236 had Psoriasis vulgaris (PsV) and 213 had PsA. Both NFB and enlarged capillaries were significantly more frequent in patients with PsA (34.7% vs 84.5%, P < 0.0001; 25.4% vs 100%, P < 0.0001). In addition, PsV patients were prospectively observed before they developed PsA (mean 21 months, 95% CI 2, 77 months). Multivariate analysis suggested that the appearance of NFB and enlarged capillaries was a predictor of PsA development (HR 2.75, 95% CI 1.38, 5.47 and HR 4.49, 95% CI 2.25, 8.96, respectively). The degree of NFC abnormalities also correlated with the severity of PsA and serum cytokine levels. CONCLUSIONS NFC abnormalities were suggested to be a predictor of PsA in psoriasis patients, and at the same time, its degree could be an indicator of disease severity.
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Affiliation(s)
- Takemichi Fukasawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Satoshi Toyama
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Enomoto
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Asako Yoshizaki-Ogawa
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yuta Norimatsu
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shoko Tateishi
- Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroko Kanda
- Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kiyoshi Miyagawa
- Laboratory of Molecular Radiology, Center for Disease Biology and Integrative Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shinichi Sato
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ayumi Yoshizaki
- Department of Dermatology, Psoriasis Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Immune-Mediated Diseases Therapy Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Garaiman A, Nooralahzadeh F, Mihai C, Gonzalez NP, Gkikopoulos N, Becker MO, Distler O, Krauthammer M, Maurer B. Vision transformer assisting rheumatologists in screening for capillaroscopy changes in systemic sclerosis: an artificial intelligence model. Rheumatology (Oxford) 2023; 62:2492-2500. [PMID: 36347487 PMCID: PMC10321092 DOI: 10.1093/rheumatology/keac541] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/14/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The first objective of this study was to implement and assess the performance and reliability of a vision transformer (ViT)-based deep-learning model, an 'off-the-shelf' artificial intelligence solution, for identifying distinct signs of microangiopathy in nailfold capilloroscopy (NFC) images of patients with SSc. The second objective was to compare the ViT's analysis performance with that of practising rheumatologists. METHODS NFC images of patients prospectively enrolled in our European Scleroderma Trials and Research group (EUSTAR) and Very Early Diagnosis of Systemic Sclerosis (VEDOSS) local registries were used. The primary outcome investigated was the ViT's classification performance for identifying disease-associated changes (enlarged capillaries, giant capillaries, capillary loss, microhaemorrhages) and the presence of the scleroderma pattern in these images using a cross-fold validation setting. The secondary outcome involved a comparison of the ViT's performance vs that of rheumatologists on a reliability set, consisting of a subset of 464 NFC images with majority vote-derived ground-truth labels. RESULTS We analysed 17 126 NFC images derived from 234 EUSTAR and 55 VEDOSS patients. The ViT had good performance in identifying the various microangiopathic changes in capillaries by NFC [area under the curve (AUC) from 81.8% to 84.5%]. In the reliability set, the rheumatologists reached a higher average accuracy, as well as a better trade-off between sensitivity and specificity compared with the ViT. However, the annotators' performance was variable, and one out of four rheumatologists showed equal or lower classification measures compared with the ViT. CONCLUSIONS The ViT is a modern, well-performing and readily available tool for assessing patterns of microangiopathy on NFC images, and it may assist rheumatologists in generating consistent and high-quality NFC reports; however, the final diagnosis of a scleroderma pattern in any individual case needs the judgement of an experienced observer.
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Affiliation(s)
- Alexandru Garaiman
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Farhad Nooralahzadeh
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Nikitas Gkikopoulos
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mike Oliver Becker
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Krauthammer
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Rheumatology and Immunology, University Hospital Bern, University of Bern, Bern, Switzerland
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Hysa E, Pizzorni C, Sammorì S, Gotelli E, Cere A, Schenone C, Ferrari G, Campitiello R, Gerli V, Paolino S, Sulli A, Smith V, Cutolo M. Microvascular damage in autoimmune connective tissue diseases: a capillaroscopic analysis from 20 years of experience in a EULAR training and research referral centre for imaging. RMD Open 2023; 9:e003071. [PMID: 37451812 DOI: 10.1136/rmdopen-2023-003071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Nailfold videocapillaroscopy (NVC) allows the detection of microvascular damage in autoimmune connective tissue diseases (CTDs). The prevalence of the morphological capillary findings was retrospectively evaluated in a wide cohort of patients with Raynaud's phenomenon secondary to a CTD at the time of the first single NVC, independently from their current treatment, autoantibody profile and comorbidities. METHODS One-thousand-one-hundred-eighty-one patients affected by CTDs were included from 2001 to 2021. The considered CTDs were systemic sclerosis (SSc), undifferentiated connective tissue disease (UCTD), mixed connective tissue disease (MCTD), dermatomyositis (DM), systemic lupus erythematosus, Sjögren's syndrome and primary antiphospholipid syndrome (aPS). The capillaroscopic parameters were distinguished between scleroderma patterns and non-scleroderma patterns. RESULTS Giant capillaries were significantly more frequent in SSc, DM and MCTD than in other CTDs (respectively, in 73%, 73% and 61% of patients, p<0.001 when comparing each rate vs the other CTDs). The mean capillary count was significantly lower in SSc, DM and MCTD (respectively, 7.04±0.18 vs 6.5±0.75 vs 7.7±2 capillaries/linear mm) compared with the other CTDs (p<0.001 for each rate vs the other CTDs). The non-specific abnormalities of capillary morphology were significantly more frequent in SSc, MCTD and aPS (respectively, in 48%, 41% and 36% of cases, all p<0.001 vs each other CTDs). CONCLUSION This large size sample of patients with CTDs, collected over 20 years of analysis, confirms the highest prevalence of specific capillaroscopic alterations in patients with SSc, DM and MCTD, when compared with other CTDs.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Silvia Sammorì
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Andrea Cere
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Giorgia Ferrari
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Rosanna Campitiello
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Veronica Gerli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), University Hospital Ghent, Gent, Belgium
- Department of Rheumatology, University Hospital Ghent, Gent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Specialties, Postgraduate School of Rheumatology, IRCCS Ospedale Policlinico San Martino, Genova, Liguria, Italy
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Onder ENA, Gokyayla E, Ermertcan AT, Ertan P. The nailfold dermoscopy findings of patients with atypical haemolytic uremic syndrome. Microvasc Res 2023; 148:104548. [PMID: 37225057 DOI: 10.1016/j.mvr.2023.104548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Hemolytic uremic syndrome (HUS) is a severe disease characterized by microangiopathic anemia, thrombocytopenia, and acute renal failure. OBJECTIVES Atypical HUS (aHUS) that results due to genetic disorders of the alternative complement pathway results in inflammation, endothelial damage, and kidney injury. Therefore, simple and non-invasive tests are needed to evaluate the activity of the disease by assessing the microvascular structure in aHUS. METHODS A dermoscope (×10) is an inexpensive and easily portable device used to visualize nailfold capillaries and has high clinical performance and interobserver reliability. In this study, the nailfold capillaries of patients with aHUS who were in remission under eculizumab treatment were examined, and the findings were compared to those of a healthy control group to evaluate disease characteristics. RESULTS All children with aHUS had decreased capillary densities even if they were in remission. This may be indicative of ongoing inflammation and microvascular damage in aHUS. CONCLUSION A dermoscopy can be used as a screening tool for disease activity in patients with aHUS.
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Affiliation(s)
- Esra Nagehan Akyol Onder
- Manisa Celal Bayar University, School of Medicine, Department of Paediatric Nephrology, Manisa TR-45010, Turkey.
| | - Ece Gokyayla
- Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa TR-45010, Turkey
| | - Aylin Turel Ermertcan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa TR-45010, Turkey
| | - Pelin Ertan
- Manisa Celal Bayar University, School of Medicine, Department of Paediatric Nephrology, Manisa TR-45010, Turkey
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Lazar LT, Guldberg-Møller J, Lazar BT, Mogensen M. Nailfold capillaroscopy as diagnostic test in patients with psoriasis and psoriatic arthritis: A systematic review. Microvasc Res 2023; 147:104476. [PMID: 36657709 DOI: 10.1016/j.mvr.2023.104476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/23/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- L T Lazar
- Department of Dermato-Venereology, Bispebjerg and Frederiksberg Hospital, University Hospitals of Copenhagen, Denmark.
| | - J Guldberg-Møller
- Department of Rheumatology, Bispebjerg and Frederiksberg Hospital, University Hospitals of Copenhagen, The Parker Institute, Denmark
| | - B T Lazar
- Department of Photonics, Technical University of Denmark, DTU, Kgs. Lyngby, Denmark
| | - M Mogensen
- Department of Dermato-Venereology, Bispebjerg and Frederiksberg Hospital, University Hospitals of Copenhagen, Denmark; Dept. of Clinical Medicine. Faculty of Health Sciences, University of Copenhagen, Denmark
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10
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Yu H, Wen Q, Zhang X, Zhang H, Wu X. Cardiac involved and autopsy in two patients with systemic sclerosis: Two cases report. Heliyon 2023; 9:e15555. [PMID: 37159691 PMCID: PMC10163610 DOI: 10.1016/j.heliyon.2023.e15555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease with high mortality. One of the most common causes of death in potential SSc patients is cardiac arrest. However, the pathogenesis of cardiac death is not very clear. As far as we know, there are few autopsy reports on this subject. Our autopsy report on two fatal cases of heart injury in SSc patients revealed evidence of myocarditis, focal myocardial necrosis, and myocardial fibrosis. Our findings suggest that chronic inflammation of the heart may lead to extensive fibrosis, which could contribute to the high mortality rate observed in SSc patients. Early detection of heart injury in SSc patients using existing technology is necessary to improve patient outcomes. Future research should focus on developing more effective methods for early detection and management of heart involvement in SSc.
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Affiliation(s)
- Hang Yu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Qinwen Wen
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
| | - Xiaolu Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Hanqing Zhang
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, PR China
| | - Xiudi Wu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, PR China
- Corresponding author.
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11
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Acemoğlu ŞŞZ, Türk İ, Aşık MA, Bircan AÖ, Deniz PP, Arslan D, Hanta İ, Ünal İ. Microvascular damage evaluation based on nailfold videocapillarosopy in sarcoidosis. Clin Rheumatol 2023:10.1007/s10067-023-06582-z. [PMID: 36964448 DOI: 10.1007/s10067-023-06582-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVES Microvascular damage is thought to play a role in the pathogenesis of sarcoidosis. We aimed to evaluate the nailfold capillaroscopy (NVC) pattern to detect microvascular changes in patients with sarcoidosis and the relationship of capillaroscopic parameters with clinical variables and disease-related measurements. PATIENTS AND METHODS Forty-two patients with sarcoidosis and 42 age- and sex-matched patients with systemic sclerosis (SSc) and healthy individuals were included in this cross-sectional case-control study. Patients aged 18-80 years who met the current American Thoracic Society criteria for sarcoidosis were included. NVC was performed by a digital microscope under a magnification of × 200. Capillary density, number of dilated, giant and neoangiogenic capillaries, capillary loop diameter, capillary shape, micro-hemorrhages, and number of avascular areas, were evaluated by an assessor who was blind to the groups allocation. RESULTS Among the capillaroscopic parameters, neoangiogenesis and dilated capillaries, which can be seen in the pattern of scleroderma, were detected in patients with sarcoidosis but not significantly different from the control group (p = 0.055; p = 0.433, respectively). The rate of tortuosity and crossing capillaries of 50% and above was significantly higher in the sarcoidosis group than in SSc and healthy controls (p < 0.05). In patients with sarcoidosis, the only statistically significant finding was; forced expiratory volume (FEV1) in one second was lower in patients with a crossed capillary rate > 50% than in patients with a crossed capillary rate of less than 50% (FEV1; 87.21 ± 19.3, 102.5 ± 14.8, p = 0.04; respectively). CONCLUSION Patients with a diagnosis of sarcoidosis have different capillaroscopic patterns. The presence of these nonspecific abnormal patterns may reflect microvascular damage in the pathophysiology of sarcoidosis. Key Points • Microvascular damage may play a role in the pathogenesis of sarcoidosis. • There may be some nonspecific abnormal findings in capillaroscopy findings in sarcoidosis. • Capillaroscopy may be valuable in reflecting sarcoidosis lung injury.
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Affiliation(s)
- Şerife Şeyda Zengin Acemoğlu
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Çukurova University, Adana, Turkey.
| | - İpek Türk
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Mehmet Ali Aşık
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ayşegül Özdoğan Bircan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Pelin Pınar Deniz
- Department of Chest Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Didem Arslan
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - İsmail Hanta
- Department of Chest Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistic, Faculty of Medicine, Çukurova University, Adana, Turkey
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12
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Smith V, Ickinger C, Hysa E, Snow M, Frech T, Sulli A, Cutolo M. Nailfold capillaroscopy. Best Pract Res Clin Rheumatol 2023; 37:101849. [PMID: 37419757 DOI: 10.1016/j.berh.2023.101849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Nailfold capillaroscopy is a safe and well-established method for the assessment of structural alterations of the microcirculation. It is a crucial tool in the investigation and monitoring of patients presenting with Raynaud's phenomenon. Detection of the characteristic "scleroderma pattern" on capillaroscopy may indicate an underlying rheumatic disease, particularly systemic sclerosis (SSc). Herein, we highlight the practical aspects of videocapillaroscopy, including image acquisition and analysis, with mention of dermoscopy. Special emphasis is placed on standardized use of terminology to describe capillary characteristics. Systematic evaluation of images in discerning the normal from the abnormal using the validated European Alliance of Associations for Rheumatology (EULAR) Study Group consensus reporting framework is paramount. In addition to the relevance of capillaroscopy in the (very) early diagnosis of SSc, its emerging predictive value (especially capillary loss) for new organ involvement and disease progression is underscored. We further provide capillaroscopic findings in selected other rheumatic diseases.
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Affiliation(s)
- Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium.
| | - Claudia Ickinger
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Marcus Snow
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tracy Frech
- Internal Medicine, Vanderbilt University Medical Center and Tennessee Valley Healthcare System Nashville, TN, USA
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
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13
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Avcı EB, Erdemir VA, Erdem O, Işık R, Aksu AEK. Evaluation of serum vascular endothelial growth factor level and findings of nailfold capillaroscopy by dermatoscope in the differential diagnosis of palmoplantar psoriasis and palmoplantar eczema. Microvasc Res 2023; 145:104441. [PMID: 36195239 DOI: 10.1016/j.mvr.2022.104441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECT This study aimed to evaluate VEGF level, capillaroscopic findings, and these features for differential diagnosis of palmoplantar psoriasis and eczema patients. METHODS This comparative cross-sectional study included 40 patients clinical and histopathologically diagnosed with eczema or psoriasis (20 psoriasis and 20 eczema) and 30 patients of similar age and gender without inflammatory disease in the control group. Serum samples of patients were collected and analyzed for VEGF by enzyme-linked immunosorbent assay (ELISA) and at the same time, we applied capillaroscopy with computerized dermatoscopy qualitatively and semiquantitatively. RESULTS In the qualitative evaluation, a decrease in capillary density and a significant increase of the avascular area was in palmoplantar plaque psoriasis (PPP) and palmoplantar eczema (PPE) patients compared to the control group. In the semiquantitative evaluation, the mean score decreased capillary density was significantly higher in PPE than in the PPP and control groups (p < 0.001). Minor morphological change (tortuous, crossed and enlarged capillary) scores were significantly higher in patients with PPE compared to PPP and control groups (p = 0.011). Major morphological change (mega, meandering, branching, bushy, bizarre, and disorganized polymorphic capillary) score was significantly higher in patients with PPP than PPE and the control group (p < 0.001). Major morphological change and m-PPPASI scores were correlated in PPP patients (p < 0.05). Disorganized capillaries in PPP patients were significantly higher than in the PPE and control groups (p < 0.001). There was no significant correlation between serum VEGF value and clinical severity and capillaroscopy findings of the patients. CONCLUSION Significant morphological changes were detected between PPP, PPE, and control groups in the qualitative and semi-quantitative evaluation of capillaroscopic findings. In the differential diagnosis of PPP and PPE, major morphological change, especially the presence of disorganized polymorphic capillaries, was considered an important finding in the capillaroscopic evaluation. These capillaroscopic findings may be helpful to discriminate eczema and psoriasis. However, there was no significant relationship between serum VEGF level and the patients' capillaroscopic findings and clinical severity.
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Affiliation(s)
- Elif Bal Avcı
- Department of Dermatology, Taksim Training and Research Hospital, Istanbul, Turkey.
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Prof Dr Süleyman Yalçın City Hospital, Medeniyet University, Istanbul, Turkey
| | - Ozan Erdem
- Department of Dermatology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Reyhan Işık
- Department of Medical Biochemistry, Istanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Ayşe Esra Koku Aksu
- Department of Dermatology, Istanbul Training and Research Hospital, Health Science University, Istanbul, Turkey
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14
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Hasseli-Fräbel R, Hermann W, Sander O, Triantafyllias K. [Nailfold capillaroscopy-Principles and clinical application]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:55-64. [PMID: 36595033 PMCID: PMC9808688 DOI: 10.1007/s00105-022-05091-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Nailfold capillaroscopy is a rapid and easily applicable differential diagnostic technique that allows direct visualization of the microcirculation. Abnormal findings in nailfold capillaroscopy are closely associated with connective tissue diseases, such as systemic sclerosis. The clinical manifestation of impaired microcirculation is Raynaud's phenomenon, which is a classical symptom of connective tissue diseases. Nailfold capillaroscopy is increasingly used in various fields of medicine, therefore it is important to define methods for the acquisition and analysis of the results of nailfold capillary and to have a uniform definition of abnormal capillaries. This article discusses image acquisition and analysis, various capillaroscopic techniques, normal and abnormal capillaroscopic features and their significance, scoring systems and reliability of image acquisition and interpretation.
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Affiliation(s)
- R. Hasseli-Fräbel
- grid.8664.c0000 0001 2165 8627Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - W. Hermann
- grid.419757.90000 0004 0390 5331Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik GmbH, Benekestr. 2–8, 61231 Bad Nauheim, Deutschland
| | - O. Sander
- grid.411327.20000 0001 2176 9917Klinik für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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15
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Wang Y, Song Z, Gao Y, Yin Y, An X, Yang J, Tao J. Nailfold capillary abnormalities: A predictor of psoriatic arthritis? J Dermatol 2022; 50:e166-e167. [PMID: 36582118 DOI: 10.1111/1346-8138.16696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Yifei Wang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Zexing Song
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Yaoying Gao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Yue Yin
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Xiangjie An
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Jing Yang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
| | - Juan Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Engineering Research Center of Skin Disease Theranostics and Health, Wuhan, China
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16
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D’Oria M, Gandin I, Riccardo P, Hughes M, Lepidi S, Salton F, Confalonieri P, Confalonieri M, Tavano S, Ruaro B. Correlation between Microvascular Damage and Internal Organ Involvement in Scleroderma: Focus on Lung Damage and Endothelial Dysfunction. Diagnostics (Basel) 2022; 13:diagnostics13010055. [PMID: 36611347 PMCID: PMC9818898 DOI: 10.3390/diagnostics13010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is an incurable connective tissue disease characterized by decreased peripheral blood perfusion due to microvascular damage and skin thickening/hardening. The microcirculation deficit is typically secondary to structural vessel damage, which can be assessed morphologically and functionally in a variety of ways, exploiting different technologies. OBJECTIVE This paper focuses on reviewing new studies regarding the correlation between microvascular damage, endothelial dysfunction, and internal organ involvement, particularly pulmonary changes in SSc. METHODS We critically reviewed the most recent literature on the correlation between blood perfusion and organ involvement. RESULTS Many papers have demonstrated the link between structural microcirculatory damage and pulmonary involvement; however, studies that have investigated correlations between microvascular functional impairment and internal organ damage are scarce. Overall, the literature supports the correlation between organ involvement and functional microcirculatory impairment in SSc patients. CONCLUSIONS Morphological and functional techniques appear to be emerging biomarkers in SSc, but obviously need further investigation.
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Affiliation(s)
- Mario D’Oria
- Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Pozzan Riccardo
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Michael Hughes
- Northern Care Alliance NHS Foundation Trust, Salford Care Organisation and Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M6 8HD, UK
| | - Sandro Lepidi
- Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-4871
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17
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El Miedany Y, Ismail S, Wadie M, Hassan M. Nailfold capillaroscopy: tips and challenges. Clin Rheumatol 2022; 41:3629-3640. [PMID: 36040673 DOI: 10.1007/s10067-022-06354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/03/2022]
Abstract
Although nailfold capillaroscopy (NFC) appears to have a bright future in clinical practice, the lack of familiarity with the technique and how to interpret its outcomes is major barriers which have made nailfold capillaroscopy an underutilized method in standard clinical practice. Traditional methods for assessment and measurement of capillary patterns, density, and blood flow are falling behind and face some challenges. In fact, there have been calls for improvement, hence the recent publication of the standardization of NFC by the EULAR Study Group on Microcirculation in Rheumatic Diseases. Nailfold capillaroscopy has the advantage of being a non-invasive technique that provides a window into the digital microcirculation. This paved the way for a rapidly growing interest in using capillaroscopy parameters as outcome measures in research. In standard clinical practice, whilst its main application is in the identification of an underlying systemic sclerosis spectrum disorder in patients presenting with Raynaud's phenomenon, its use has expanded to include other clinical features possibly suggestive of an underlying connective tissue disease. This article presents the challenges, provides tips, and highlights the exciting potential of nailfold capillaroscopy in standard practice.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, Institute of Medical Sciences, Canterbury, England, UK.
| | - Sherif Ismail
- Rheumatology and Rehabilitation, Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Mary Wadie
- Internal Medicine Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
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18
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Todoroki Y, Kubo S, Nakano K, Miyazaki Y, Ueno M, Satoh-Kanda Y, Kanda R, Miyagawa I, Hanami K, Nakatsuka K, Saito K, Nakayamada S, Tanaka Y. Nailfold microvascular abnormalities are associated with a higher prevalence of pulmonary arterial hypertension in patients with MCTD. Rheumatology (Oxford) 2022; 61:4875-4884. [PMID: 35285493 DOI: 10.1093/rheumatology/keac165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/04/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE MCTD manifests with microvasculopathy and overlapping clinical features of SLE, SSc and idiopathic inflammatory myopathies (IIM). The aim of this study was to investigate the clinical significance of microvasculopathy in patients with MCTD using nailfold videocapillaroscopy (NVC). METHODS Fifty patients with newly diagnosed and untreated MCTD were enrolled in this multicentre, prospective and observational study. Clinical features and NVC findings were assessed at baseline and after 1 year post-intervention, along with disease controls [SLE (n = 40), SSc (n = 70) and IIM (n = 50)]. RESULTS All MCTD patients presented Raynaud's phenomenon and were positive for anti-U1 RNP antibodies, and 22.0% (11/50) had pulmonary arterial hypertension (PAH). The prevalence of NVC scleroderma patterns in MCTD was 38.0%, which was lower than SSc (88.6%) but higher than SLE (10.0%). In addition, when we divided MCTD patients into two groups by presence or absence of NVC scleroderma patterns, we found a higher prevalence of PAH in patients with NVC scleroderma patterns. Namely, NVC scleroderma patterns were observed in all MCTD patients with PAH, and in 21.0% of those without PAH. After intensive immunosuppressive therapy, NVC scleroderma patterns disappeared in half of the MCTD patients but were not changed in SSc patients. CONCLUSIONS MCTD differed from SLE, SSc and IIM in terms of the prevalence and responsiveness of NVC scleroderma patterns to immunosuppressive therapy. Detection of nailfold microvascular abnormalities in MCTD could contribute to predicting PAH and help us to understand further aspects of the pathogenesis of MCTD.
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Affiliation(s)
- Yasuyuki Todoroki
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Satoshi Kubo
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhisa Nakano
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yusuke Miyazaki
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masanobu Ueno
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yurie Satoh-Kanda
- Department of Internal Medicine, Kitakyushu General Hospital, Kitakyushu, Japan
| | - Ryuichiro Kanda
- Department of Internal Medicine, Kitakyushu General Hospital, Kitakyushu, Japan
| | - Ippei Miyagawa
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Kentaro Hanami
- Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu
| | - Keisuke Nakatsuka
- Department of Internal Medicine, Fukuoka Yutaka Central Hospital, Fukuoka
| | - Kazuyoshi Saito
- Department of Internal Medicine, Tobata General Hospital, Kitakyushu, Japan
| | - Shingo Nakayamada
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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Melsens K, Cutolo M, Schonenberg-Meinema D, Foeldvari I, Leone MC, Mostmans Y, Badot V, Cimaz R, Dehoorne J, Deschepper E, Frech T, Hernandez-Zapata J, Ingegnoli F, Khan A, Krasowska D, Lehmann H, Makol A, Mesa-Navas MA, Michalska-Jakubus M, Müller-Ladner U, Nuño-Nuño L, Overbury R, Pizzorni C, Radic M, Ramadoss D, Ravelli A, Rosina S, Udaondo C, van den Berg MJ, Herrick AL, Sulli A, Smith V. Standardised nailfold capillaroscopy in children with rheumatic diseases: a worldwide study. Rheumatology (Oxford) 2022; 62:1605-1615. [PMID: 36005889 PMCID: PMC10070071 DOI: 10.1093/rheumatology/keac487] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/11/2022] [Accepted: 07/17/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To standardly assess and describe nailfold videocapillaroscopy (NVC) assessment in children and adolescents with juvenile rheumatic and musculoskeletal diseases (jRMD) versus healthy controls (HC). METHODS In consecutive jRMD children and matched HC from 13 centres worldwide, 16 NVC images per patient were acquired locally and read centrally per international consensus standard evaluation of the EULAR Study Group on Microcirculation in Rheumatic Diseases. 95 patients with juvenile idiopathic arthritis (JIA), 22 with dermatomyositis (JDM), 20 with systemic lupus erythematosus (cSLE), 13 with systemic sclerosis (jSSc), 21 with localized scleroderma (lSc), 18 with mixed connective tissue disease (MCTD) and 20 with primary Raynaud's phenomenon (PRP) were included. NVC differences between juvenile subgroups and HC were calculated through multivariable regression analysis. RESULTS A total number of 6474 images were assessed from 413 subjects (mean age 12.1-years, 70.9% female). The quantitative NVC-characteristics were significantly lower (↓) or higher (↑) in the following subgroups compared to HC: For density: ↓ in jSSc, JDM, MCTD, cSLE and lSc; For dilations: ↑ in jSSc, MCTD and JDM; For abnormal shapes: ↑ JDM and MCTD; For haemorrhages: ↑ in jSSc, MCTD, JDM and cSLE. The qualitative NVC-assessment of JIA, lSc and PRP did not differ from HC, whereas the cSLE and jSSc, MCTD, JDM, cSLE subgroups showed more non-specific and scleroderma patterns respectively. CONCLUSION This analysis resulted from a pioneering registry of NVC in jRMD. The NVC-assessment in jRMD differed significantly from HC. Future prospective follow up will further elucidate the role of NVC in jRMD.
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Affiliation(s)
- Karin Melsens
- Dpt of Rheumatology, Ghent University Hospital; Dpt of Internal Medicine, Ghent University, Ghent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Dieneke Schonenberg-Meinema
- Dpt of Pediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Ivan Foeldvari
- Centre for Paediatric and Adolescent Rheumatology, An der Schön Klinik, Hamburg, Germany
| | - Maria C Leone
- Dpt of Rheumatology, Ghent University Hospital, Ghent, Belgium; Medical and rheumatological clinic, S. Maria Hospital, Terni, Italy
| | - Yora Mostmans
- Dpt of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB); Dpt of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valérie Badot
- Dpt of Rheumatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rolando Cimaz
- Pediatric Rheumatology Unit, Gaetano Pini Hospital, Dpt of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Joke Dehoorne
- Dpt of Pediatric Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deschepper
- Dpt of Public Health and Primary Care, Biostatistics Unit, Ghent University, Ghent, Belgium
| | - Tracy Frech
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology; Salt Lake Veterans Affair Medical Centre, Utah Vascular Research Laboratory, Salt Lake City, Utah, USA
| | | | - Francesca Ingegnoli
- Clinical Rheumatology Unit, Gaetano Pini Hospital, Dpt of Clinical Sciences and Community Health, Research Centre for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Archana Khan
- Dpt of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Dorota Krasowska
- Dpt of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | - Hartwig Lehmann
- Dpt of Pediatrics, University Medicine Gießen, Gießen, Germany
| | - Ashima Makol
- Div of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Miguel A Mesa-Navas
- Rheumatology Section, Clínica Universitaria Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - Ulf Müller-Ladner
- Dpt of Rheumatology and clinical immunology, Campus Kerckhoff, Justus-Liebig University, Gießen; Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | | | - Rebecca Overbury
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology; University of Utah, Dpt of Pediatrics, Div of Pediatric Rheumatology, Salt Lake City, Utah, USA
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Mislav Radic
- University of Utah, Dpt of Internal Medicine, Div of Rheumatology, Salt Lake City, Utah, USA; University Hospital Split, Split, Croatia
| | - Divya Ramadoss
- Dpt of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini; University of Genoa, Genoa, Italy; Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clara Udaondo
- Pediatric Rheumatology Dept., La Paz Children's Hospital, Madrid, Spain
| | - Merlijn J van den Berg
- Dpt of Pediatric Immunology, Rheumatology and Infectious diseases, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Dpt of Internal Medicine, University of Genova; IRCCS San Martino Polyclinic, Genoa, Italy
| | - Vanessa Smith
- Dpt of Rheumatology, Ghent University Hospital; Dpt of Internal Medicine, Ghent University; Unit for Molecular Immunology and Inflammation, Inflammation Research Centre, VIB-Ghent University, Ghent, Belgium
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20
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Anyfanti P, Angeloudi E, Dara A, Arvanitaki A, Bekiari E, Kitas GD, Dimitroulas T. Nailfold Videocapillaroscopy for the Evaluation of Peripheral Microangiopathy in Rheumatoid Arthritis. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081167. [PMID: 36013346 PMCID: PMC9410266 DOI: 10.3390/life12081167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic and refractory autoimmune joint disease that affects multiple organs. Several methods have been applied for the study of microvascular endothelial dysfunction, which is considered an important component of vascular disease in RA. Implementation of nailfold videocapillaroscopy (NVC) represents a viable choice, as the skin is an easily accessible window for the non-invasive, real-time assessment of subtle microcirculation abnormalities. Although NVC is routinely used in the rheumatology field, especially for the diagnostic workout of Raynaud’s phenomenon, accumulating evidence suggests a role in the evaluation of systemic vasculopathy associated with autoimmune rheumatic disorders. The current paper aims to provide an overview of NVC as a valuable clinical aid for the assessment of peripheral microcirculation in RA. Previous studies characterizing the capillaroscopic pattern in RA are summarized, along with associations with disease-related characteristics. Most available reports have mainly focused on the descriptions of non-specific morphological alterations that may reflect endothelial injury over the course of the disease. Still, the exact pattern of structural and functional capillaroscopic alterations and their clinical significance in RA remains a subject of ongoing research.
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Affiliation(s)
- Panagiota Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.A.); (E.B.)
- Correspondence:
| | - Elena Angeloudi
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.A.); (E.B.)
| | - Athanasia Dara
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (A.D.); (A.A.); (T.D.)
| | - Alexandra Arvanitaki
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (A.D.); (A.A.); (T.D.)
- First Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Eleni Bekiari
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (E.A.); (E.B.)
| | - George D. Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS Foundation Trust, Dudley DY1 2HQ, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece; (A.D.); (A.A.); (T.D.)
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21
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Hasseli-Fräbel R, Hermann W, Sander O, Triantafyllias K. [Nailfold capillaroscopy-Principles and clinical application]. Z Rheumatol 2022; 81:313-322. [PMID: 35445832 PMCID: PMC9022415 DOI: 10.1007/s00393-022-01200-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 10/31/2022]
Abstract
Nailfold capillaroscopy is a rapid and easily applicable differential diagnostic technique that allows direct visualization of the microcirculation. Abnormal findings in nailfold capillaroscopy are closely associated with connective tissue diseases, such as systemic sclerosis. The clinical manifestation of impaired microcirculation is Raynaud's phenomenon, which is a classical symptom of connective tissue diseases. Nailfold capillaroscopy is increasingly used in various fields of medicine, therefore it is important to define methods for the acquisition and analysis of the results of nailfold capillary and to have a uniform definition of abnormal capillaries. This article discusses image acquisition and analysis, various capillaroscopic techniques, normal and abnormal capillaroscopic features and their significance, scoring systems and reliability of image acquisition and interpretation.
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Affiliation(s)
- R Hasseli-Fräbel
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - W Hermann
- Abteilung für Rheumatologie und Klinische Immunologie, Kerckhoff-Klinik GmbH, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - O Sander
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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22
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Piette Y, Reynaert V, Vanhaecke A, Bonroy C, Gutermuth J, Sulli A, Cutolo M, Smith V. Standardised interpretation of capillaroscopy in autoimmune idiopathic inflammatory myopathies: A structured review on behalf of the EULAR study group on microcirculation in Rheumatic Diseases. Clin Exp Rheumatol 2022; 21:103087. [PMID: 35421608 DOI: 10.1016/j.autrev.2022.103087] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We conducted a systematic review, on behalf of the EULAR Study Group on Microcirculation in Rheumatic Diseases (EULAR SG MC/RD), to investigate the value of nailfold videocapillaroscopy (NVC) in idiopathic inflammatory myopathies (IIM). METHODS Three electronic databases were systematically searched to find all relevant manuscripts reporting NVC outcomes in IIM patients. Articles were assessed based on study design, population, NVC methodology and description of NVC results. To allow comparison between the articles, all NVC results were interpreted according to standardised capillaroscopic terminology, as previously consented by the EULAR SG MC/RD and the Scleroderma Clinical Trials Consortium (SCTC) Group on Capillaroscopy. RESULTS Of the 653 identified records; five were retained after critical appraisal on title, abstract and manuscript level. A marked difference in NVC was observed between (juvenile) dermatomyositis [(j)DM] versus polymyositis, healthy controls and systemic sclerosis patients. In addition, reduced capillary density and scleroderma pattern seem to be associated with active disease in (j)DM, while immunosuppressive treatment appears to reduce NVC abnormalities. CONCLUSION This is the first systematic review investigating NVC in IIM, interpreting the results according to an international consented standardised manner, as proposed by the EULAR SG MC/RD and SCTC Group on Capillaroscopy. We can conclude that NVC presents a promising asset in the diagnosis of (j)DM. Moreover, NVC could be a biomarker for organ involvement and follow-up. Large multicentre prospective standardised studies are further needed to definitely describe associations with clinical and laboratory parameters in the different IIM subtypes.
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Affiliation(s)
- Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Valerie Reynaert
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, SKIN research group, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Carolien Bonroy
- Department of Laboratory Medicine, Ghent University Hospital, Department of Diagnostic Sciences, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Jan Gutermuth
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, SKIN research group, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, 9000 Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Technologiepark-Zwijnaarde 71, 9052, Ghent, Belgium.
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23
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Li AR, Burke CD, Purvis CS, Lee LW. Association between nailfold capillaroscopy abnormalities and autoimmune disease in pediatric populations. Pediatr Dermatol 2022; 39:197-204. [PMID: 35078273 DOI: 10.1111/pde.14926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Time to diagnosis of autoimmune disease in pediatric populations can take years but nailfold capillaroscopy (NFC) may identify early signs of autoimmune disease. The aim of this study is to assess the association between nailfold capillary abnormalities and autoimmune disease in children. METHODS A systematic search of PubMed, EMBASE, and Scopus was performed to identify all studies published before March 17, 2021. Observational studies reporting NFC outcomes in children with autoimmune disease and healthy controls (HC) were eligible for inclusion. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effects meta-analytical model. RESULTS Nine of 3665 studies reporting on 641 patients (398 subjects, 243 controls) were included. Pediatric patients with autoimmune disease were 9.88 (95% CI 3.16-30.87, I2 = 80.1%) times more likely to have abnormal nailfold capillaries than HC. Of the capillaroscopic features, dilated capillaries (OR 27.90, 95% CI 2.17-349.05, I2 = 59.9%) were the most likely abnormality observed on NFC. This was followed by the likelihood of reduced capillary density (<7 capillaries/mm) (OR 19.91, 95% CI 3.79-105.52, I2 = 0%), giant capillaries (OR 12.87, 95% CI 2.38-69.45, I2 = 0%), hemorrhages (OR 13.89, 95% CI 5.34-36.16, I2 = 0%), and avascularity (OR 10.38, 95% CI 2.20-49.04, I2 = 0%). CONCLUSIONS Children with autoimmune disease are significantly more likely to have nailfold capillary abnormalities. NFC may be useful in identifying early signs of underlying rheumatic disease and potentially decrease the time to diagnosis for this patient population.
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Affiliation(s)
- Andraia R Li
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Connor D Burke
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Colby S Purvis
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lara Wine Lee
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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24
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Vanhaecke A, Cutolo M, Distler O, Riccieri V, Allanore Y, Denton CP, Hachulla E, Ingegnoli F, Deschepper E, Avouac J, Jordan S, Launay D, Melsens K, Pizzorni C, Sulli A, Vasile M, Herrick AL, Smith V. Nailfold capillaroscopy in SSc: innocent bystander or promising biomarker for novel severe organ involvement/progression? Rheumatology (Oxford) 2022; 61:4384-4396. [PMID: 35176132 PMCID: PMC9629390 DOI: 10.1093/rheumatology/keac079] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Nailfold videocapillaroscopy (NVC) plays a well-established role in differentiating primary from secondary RP due to SSc. However, the association of NVC with novel severe organ involvement/progression in SSc has never been evaluated in a multicentre, multinational study, which we now perform for the first time. Methods Follow-up data from 334 SSc patients [265 women; 18 limited SSc (lSSc)/203 lcSSc/113 dcSSc] registered between November 2008 and January 2016 by seven tertiary centres in the EUSTAR-database, were analysed. Novel severe organ involvement/progression was defined as new/progressive involvement of the peripheral vasculature, lungs, heart, skin, gastrointestinal tract, kidneys, musculoskeletal system, or death, at the 12- or 24-month follow-up. NVC images at enrolment were quantitatively and qualitatively evaluated according to the standardized definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Uni- and multivariable logistic regression modelling (ULR, MLR) was performed. Results Of the 334 included SSc patients, 257 (76.9%) developed novel overall severe organ involvement/progression. Following MLR, normal capillary density was associated with less-frequent novel overall severe organ involvement/progression [odds ratio (OR) = 0.77, P < 0.001] and novel peripheral vascular involvement (OR = 0.79, P = 0.043); microhaemorrhages were associated with less novel pulmonary hypertension (OR = 0.47, P = 0.029); and a ‘severe’ (active/late) NVC pattern was associated with novel overall severe organ involvement/progression (OR = 2.14, P = 0.002) and skin progression (OR = 1.70, P = 0.049). Conclusions Our results suggest that NVC may be a promising biomarker in SSc, certainly warranting further investigation. Despite the participation of tertiary centres, which follow their patients in a standardized way, we were underpowered to detect associations with infrequent severe organ involvement/progression.
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Affiliation(s)
- Amber Vanhaecke
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Yannick Allanore
- Service de Rheumatology, Université de Paris, Höpital Cochin, AP-HP CUP, Paris, France
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Eric Hachulla
- Institute for Translational Research in Inflammation (INFINITE), Université de Lille, Lille, France.,INSERM, Lille, France.,Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Francesca Ingegnoli
- Division of Clinical Rheumatology, ASST Pini-CTO, Milano, Italy; Dept of Clinical Sciences & Community Health, Università degli Studi di Milano, Milano, Italy
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jérôme Avouac
- Service de Rheumatology, Université de Paris, Höpital Cochin, AP-HP CUP, Paris, France
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David Launay
- Institute for Translational Research in Inflammation (INFINITE), Université de Lille, Lille, France.,INSERM, Lille, France.,Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Karin Melsens
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Massimiliano Vasile
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
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25
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Ljubojević V, Bojanić V, Nožica-Radulović T, Draganović D, Skočić-Smoljanović S. The research of correlation between blood pressure and nailfold capillary parameters in exercising and non-exercising pregnant women. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-38104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background/Aim: With an increase in cardiac output, blood pressure values in pregnancy increase. The aim of the study was to examine the effect of prenatal exercises on the circulatory parameters and the correlation between blood pressure and nailfold capillary parameters in healthy pregnant women. Methods: The blood pressure shape and length of nailfold capillary were assessed in 35 non-exercising pregnant women and 35 pregnant women who exercised, at the beginning of the study (between 20 and 32 gestational week) and the end of the study (28 - 40 gestational week). Results: The elevation in blood pressure was significantly lower in pregnant women who exercised in relation to non-exercising pregnant women. After eight weeks, the length of the capillary loops was increased by 30 µm and the number of pregnant women with pronounced shape changes of capillary loops increased, with no difference between the groups. Non-exercisers had a correlation between the change in diastolic pressure and the increase in capillary length (r = 0.53, p = 0.001). In the experimental group, the correlation between the change in blood pressure and the increase in the length of capillary loops was not determined. Conclusion: Prenatal physical activity had a beneficial impact on the circulation of pregnant women. In pregnant women in the third trimester, after eight weeks of follow-up, the length of the nailfold capillary loops and the presence of pronounced shape changes of capillary loops were increased, without difference between exercisers and non-exercisers. In non-exercising pregnant women, the capillary length was increased with the elevation of diastolic blood pressure, while the correlation was not found in pregnant women who exercised.
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26
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Nawaz I, Nawaz Y, Nawaz E, Manan MR, Mahmood A. Raynaud's Phenomenon: Reviewing the Pathophysiology and Management Strategies. Cureus 2022; 14:e21681. [PMID: 35242466 PMCID: PMC8884459 DOI: 10.7759/cureus.21681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/25/2022] [Indexed: 12/27/2022] Open
Abstract
Raynaud's phenomenon (RP) is a multifactorial vasospastic disorder characterized by a transient, recurrent, and reversible constriction of peripheral blood vessels. RP is documented to affect up to 5% of the general population, but variation in its prevalence is commonly recognized owing to many factors, including varied definitions, gender, genetics, hormones, and region. Furthermore, RP may be idiopathic or be a clinical manifestation of an underlying illness. Patients with RP classically describe a triphasic discoloration of the affected area, beginning with pallor, followed by cyanosis, and finally ending with erythema. This change in color spares the thumb and is often associated with pain. Each attack may persist from several minutes to hours. Moreover, the transient cessation of blood flow in RP is postulated to be mediated by neural and vascular mechanisms. Both structural and functional alterations observed in the blood vessels contribute to the vascular abnormalities documented in RP. However, functional impairment serves as a primary contributor to the pathophysiology of primary Raynaud's. Substances like endothelin-1, angiotensin, and angiopoietin-2 play a significant role in the vessel-mediated pathophysiology of RP. The role of nitric oxide in the development of this phenomenon is still complex. Neural abnormalities resulting in RP are recognized as either being concerned with central mechanisms or peripheral mechanisms. CNS involvement in RP may be suggested by the fact that emotional distress and low temperature serve as major triggers for an attack, but recent observations have highlighted the importance of locally produced factors in this regard as well. Impaired vasodilation, increased vasoconstriction, and several intravascular abnormalities have been documented as potential contributors to the development of this disorder. RP has also been observed to occur as a side effect of various drugs. Recent advances in understanding the mechanism of RP have yielded better pharmacological therapies. However, general lifestyle modifications along with other nonpharmacological interventions remain first-line in the management of these patients. Calcium channel blockers, alpha-1 adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors, nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors are some of the common classes of drugs that have been found to be therapeutically significant in the management of RP. Additionally, anxiety management, measures to avoid colder temperatures, and smoking cessation, along with other simple modifications, have proven to be effective non-drug strategies in patients experiencing milder symptoms.
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Affiliation(s)
- Iqra Nawaz
- Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | | | - Eisha Nawaz
- Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | | | - Adil Mahmood
- Medicine, Bahawal Victoria Hospital, Bahawalpur, PAK
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Bardehle F, Sies K, Enk A, Rosenberger A, Fink C, Haenssle H. Mikrovaskuläre Pathologien bei Patienten mit Psoriasis vulgaris mittels Nagelfalzkapillarmikroskopie identifiziert: Ergebnisse einer prospektiven kontrollierten Studie. J Dtsch Dermatol Ges 2021; 19:1736-1745. [PMID: 34894181 DOI: 10.1111/ddg.14606_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund: Die Psoriasis gilt als unabhängiger kardiovaskulärer Risikofaktor und Treiber einer Atherogenese. Mikrovaskuläre Veränderungen in psoriatischen Plaques sind gut beschrieben, wohingegen Veränderungen außerhalb betroffener Hautareale kaum untersucht wurden. In dieser Studie wurden Nagelfalzkapillaren von Psoriasispatienten in nicht betroffener Haut systematisch untersucht. Patienten und Methodik: Prospektive Studie mit Untersuchung von Nagelfalzkapillaren bei Psoriasispatienten im Vergleich zu gesunden Kontrollen mittels digitaler Videokapillarmikroskopie. Es wurden 21 kapillarmikroskopische Parameter bewertet und die Ergebnisse mit Charakteristika der Patienten und der Psoriasiserkrankung, mit Laborparametern und Messungen der Intima-Media-Dicke der Arteria carotis communis korreliert. Ergebnisse: Die 77 Psoriasispatienten (24 mit zusätzlicher Psoriasisarthritis) und 71 Kontrollen zeigten sich hinsichtlich demographischer Merkmale und relevanter Einflussfaktoren für eine Mikroangiopathie ausbalanciert. Im Vergleich zur Kontrollgruppe zeigten Psoriasispatienten eine signifikante Minderung der kapillaren Dichte, häufigere Kapillarerweiterung mit mehr Verzweigungen, Torquierungen und kapillaren Unregelmäßigkeiten. Zusätzlich zeigten Psoriasispatienten signifikant höhere inflammatorische Serummarker und eine gesteigerte Intima-Media-Dicke. In unserem Kollektiv bestand kein Zusammenhang zwischen Krankheitsdauer oder Schweregrad der Psoriasis und spezifischen Kapillarveränderungen. Schlussfolgerungen: Die Nagelfalzkapillaren der untersuchten Psoriasispatienten zeigten ausgeprägte mikrovaskuläre Veränderungen, welche mit erhöhten Markern einer systemischen Entzündung und Frühzeichen einer Atherosklerose korrelierten. Weitere Studien sind erforderlich, um die Rolle der digitalen Videokapillarmikroskopie in der Bewertung des kardiovaskulären Risikos von Psoriasispatienten zu untersuchen.
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Bardehle F, Sies K, Enk A, Rosenberger A, Fink C, Haenssle H. Nailfold videocapillaroscopy identifies microvascular pathologies in psoriasis vulgaris: Results of a prospective controlled study. J Dtsch Dermatol Ges 2021; 19:1736-1744. [PMID: 34792866 DOI: 10.1111/ddg.14606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis is considered an independent cardiovascular risk factor, evidentially driving atherosclerosis. However, little is known about changes in the microvasculature of non-lesional skin in psoriasis patients. This study systematically examined capillary pathologies in psoriasis patients by digital video nailfold capillaroscopy. PATIENTS AND METHODS Prospective study comparing nailfold capillaries of psoriasis patients with those of healthy controls. Nailfold capillaries were evaluated for 21 parameters and results were correlated with characteristics of patients and psoriatic disease, laboratory parameters, and measurements of carotid intima-media thickness. RESULTS 77 psoriasis patients (24 patients with additional psoriatic arthritis) and 71 controls were well-matched for demographic features and for relevant confounding factors causing microangiopathy. In comparison with controls, psoriasis patients showed a significant loss of capillaries, capillary expansion with increased ramifications and tortuosity and capillary irregularities. Moreover, in psoriasis patients we found significantly elevated serum markers of inflammation and significantly increased intima-media-thickness measurements. We found no effect of disease duration nor disease activity on capillary changes. CONCLUSIONS Nailfold capillaries of psoriasis patients showed marked microvascular abnormalities accompanied by increased markers of systemic inflammation and atherosclerosis. Prospective cohort studies are needed to assess the role of nailfold capillaroscopy for predicting the cardiovascular risk of psoriasis patients.
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Affiliation(s)
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Germany
| | | | - Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
| | - Holger Haenssle
- Department of Dermatology, University of Heidelberg, Germany
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Detection of microvascular changes in systemic sclerosis and other rheumatic diseases. Nat Rev Rheumatol 2021; 17:665-677. [PMID: 34561652 DOI: 10.1038/s41584-021-00685-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Morphological and functional analysis of the microcirculation are objective outcome measures that are recommended for use in the presence of clinical signs of altered peripheral blood flow (such as Raynaud phenomenon), which can occur in systemic sclerosis (SSc) and other autoimmune rheumatic diseases. Several advanced non-invasive tools are available for monitoring the microcirculation, including nailfold videocapillaroscopy, which is the best-studied and most commonly used method for distinguishing and quantifying microvascular morphological alterations in SSc. Nailfold videocapillaroscopy can also be used alongside laser Doppler techniques to assist in the early diagnosis and follow-up of patients with dermatomyositis or mixed connective tissue disease. Power Doppler ultrasonography, which has been used for many years to evaluate the vascularity of synovial tissue in rheumatoid arthritis, is another promising tool for the analysis of skin and nailbed capillary perfusion in other autoimmune rheumatic diseases. Other emerging methods include raster-scanning optoacoustic mesoscopy, which offers non-invasive high-resolution 3D visualization of capillaries and has been tested in psoriatic arthritis and SSc. The principle functions and operative characteristics of several non-invasive tools for analysing microvascular changes are outlined in this Review, and the clinical roles of validated or tested imaging methods are discussed for autoimmune rheumatic diseases.
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Sugimoto T, Mokuda S, Kohno H, Ishitoku M, Araki K, Watanabe H, Tokunaga T, Yoshida Y, Hirata S, Sugiyama E. Nailfold capillaries and myositis specific antibodies in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis. Rheumatology (Oxford) 2021; 61:2006-2015. [PMID: 34498053 DOI: 10.1093/rheumatology/keab681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/01/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aimed to quantify nailfold capillary (NFC) abnormalities in anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis (DM) patients and to evaluate the association with clinical parameters, including serum biomarkers. In addition, we aimed to clarify the period leading to remission of NFC abnormalities during immunosuppressive treatment in patients with DM. METHODS A prospective observational study was conducted including patients (n = 10) who first visited Hiroshima University Hospital and were diagnosed with DM or clinically amyopathic dermatomyositis (CADM) with anti-MDA5 antibodies. We compared the NFC abnormalities detected by nailfold-video capillaroscopy (NVC), physical findings, blood tests, respiratory function tests, and vascular-related growth factors measured using a LEGENDplexTM Multi-Analyte Flow Assay Kit. RESULTS NFC abnormalities improved in all patients from 2-17 weeks after the initiation of immunosuppressive treatment. The NVC scores were inversely correlated with anti-MDA5 antibody titres at baseline. NVC scores and forced vital capacity (FVC) were positively correlated. Baseline with macrophage colony-stimulating factor (M-CSF) and stem cell factor (SCF) was correlated with anti-MDA-5 titres. CONCLUSION Our study suggests that NVC scores and disease activity are inversely correlated before treatment. Vascular-related growth factors, such as M-CSF and SCF, may be associated with the disease mechanism in patients with anti-MDA5 antibody-positive DM.
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Affiliation(s)
- Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Hiroki Kohno
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Michinori Ishitoku
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Kei Araki
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Hirofumi Watanabe
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Tadahiro Tokunaga
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Kasumi, Hiroshima, Japan
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Nagy G, Czirják L, Kumánovics G. Patients with Systemic Sclerosis with and without Overlap Syndrome Show Similar Microvascular Abnormalities. Diagnostics (Basel) 2021; 11:1606. [PMID: 34573948 PMCID: PMC8468290 DOI: 10.3390/diagnostics11091606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Nailfold video capillaroscopy (NVC) is a useful tool for measuring capillary density (CD) and capillary morphology parameters and is mainly used in systemic sclerosis (SSc). OBJECTIVE We aimed to assess the prevalence of an SSc pattern and CD in different connective tissue diseases (CTDs). METHODS NVC was performed on 268 patients with CTDs. Control groups consisted of 104 healthy volunteers (HVs) and 36 primary Raynaud's patients (PRPs). RESULTS Decreased CD was more prevalent in SSc, systemic lupus erythematosus (SLE), inflammatory myopathies (IIM), and overlap CTD patients compared with both controls. Average CD, the prevalence of decreased CD, and the prevalence of an SSc pattern did not differ significantly between SSc patients with (n = 39) and without (n = 50) overlap syndrome. An SSc pattern was significantly more prevalent in SLE (23%), SSc (82%), IIM (35%), and rheumatoid arthritis (17%) compared with both control groups. The prevalence of an elevated microangiopathy evaluation score (MES) was significantly higher in SLE, SSc, and IIM than in the HVs. CONCLUSION The presence of another CTD in SSc did not influence CD or morphology. An SSc pattern may also be present in CTDs other than SSc. The MES is a useful instrument to distinguish between patients with CTDs and controls.
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Affiliation(s)
| | | | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Akác Street 1, 7362 Pécs, Hungary; (G.N.); (L.C.)
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Ingegnoli F, Herrick AL, Schioppo T, Bartoli F, Ughi N, Pauling JD, Sulli A, Cutolo M, Smith V. Reporting items for capillaroscopy in clinical research on musculoskeletal diseases: a systematic review and international Delphi consensus. Rheumatology (Oxford) 2021; 60:1410-1418. [PMID: 32984894 DOI: 10.1093/rheumatology/keaa457] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/01/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The level of detail included when describing nailfold videocapillaroscopy (NVC) methods varies among research studies, making interpretation and comparison of results challenging. The overarching objective of the present study was to seek consensus on the reporting standards in NVC methodology for clinical research in rheumatic diseases and to propose a pragmatic reporting checklist. METHODS Based on the items derived from a systematic review focused on this topic, a three-step web-based Delphi consensus on minimum reporting standards in NVC was performed among members of the European League against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium. RESULTS A total of 319 articles were selected by the systematic review, and 46 items were proposed in the Delphi process. This Delphi exercise was completed by 80 participants from 31 countries, including Australia and countries within Asia, Europe, North America and South America. Agreement was reached on items covering three main areas: patient preparation before NVC (15 items), device description (5 items) and examination details (13 items). CONCLUSION Based on the available evidence, the description of NVC methods was highly heterogeneous in the identified studies and differed markedly on several items. A reporting checklist of 33 items, based on practical suggestions made (using a Delphi process) by international participants, has been developed to provide guidance to improve and standardize the NVC methodology to be applied in future clinical research studies.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tommaso Schioppo
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Francesca Bartoli
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - Nicola Ughi
- Division of Clinical Rheumatology, Pini Hospital, Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Italy
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS FT, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Hospital, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
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Shikama M, Sonoda N, Morimoto A, Suga S, Tajima T, Kozawa J, Maeda N, Otsuki M, Matsuoka T, Shimomura I, Ohno Y. Association of crossing capillaries in the finger nailfold with diabetic retinopathy in type 2 diabetes mellitus. J Diabetes Investig 2021; 12:1007-1014. [PMID: 33070436 PMCID: PMC8169354 DOI: 10.1111/jdi.13444] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/09/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS/INTRODUCTION Crossing capillaries in the finger nailfold might potentially be a novel diabetic retinopathy (DR) biomarker that could be assessed non-invasively in the clinical setting. However, the association between crossing capillaries and DR is controversial. This study aimed to investigate the association between the percentage of crossing capillaries in the finger nailfold and DR in patients with type 2 diabetes mellitus. MATERIALS AND METHODS This cross-sectional study enrolled 108 type 2 diabetes mellitus patients (aged 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital, Osaka, Japan, between May and October 2019. Capillary morphology was assessed using nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. Details of DR and other laboratory data were obtained from medical records. The association between the tertile of the percentage of the crossing capillary and DR was analyzed using multivariable logistic regression. RESULTS After adjusting for age, sex, diabetes duration, glycated hemoglobin, systolic blood pressure, body mass index, and use of renin-angiotensin system inhibitor and antihyperlipidemic medication, the percentage of crossing capillaries was significantly associated with DR (multivariable-adjusted odds ratios for increasing tertiles of the percentage of crossing capillary: 1 [reference], 2.05 [95% confidence interval 0.53-7.94], and 4.33 [95% confidence interval 1.16-16.21]; P-trend = 0.028). CONCLUSIONS A higher percentage of crossing capillaries in the nailfold was associated with a higher risk of DR, independent of traditional risk and inhibiting factors, in patients with type 2 diabetes mellitus.
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Affiliation(s)
- Maiko Shikama
- Department of Mathematical Health ScienceGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Nao Sonoda
- Department of Fundamental NursingGraduate School of NursingOsaka Prefecture UniversityHabikinoJapan
| | - Akiko Morimoto
- Department of Fundamental NursingGraduate School of NursingOsaka Prefecture UniversityHabikinoJapan
| | - Sayaka Suga
- Department of Mathematical Health ScienceGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Tetsuya Tajima
- Department of Mathematical Health ScienceGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Junji Kozawa
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
- Department of Diabetes Care MedicineGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Norikazu Maeda
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
- Department of Metabolism and AtherosclerosisGraduate School of MedicineOsaka UniversitySuitaJapan
| | - Michio Otsuki
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Taka‐Aki Matsuoka
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Iichiro Shimomura
- Department of Metabolic MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Yuko Ohno
- Department of Mathematical Health ScienceGraduate School of MedicineOsaka UniversitySuitaJapan
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van Leeuwen NM, Boonstra M, Bakker JA, Grummels A, Jordan S, Liem S, Distler O, Hoffmann-Vold AM, Melsens K, Smith V, Truchetet ME, Scherer HU, Toes R, Huizinga TWJ, de Vries-Bouwstra JK. Anti-centromere antibody levels and isotypes and the development of systemic sclerosis. Arthritis Rheumatol 2021; 73:2338-2347. [PMID: 34042326 PMCID: PMC9297867 DOI: 10.1002/art.41814] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
Objective Little is known on the disease course of very early systemic sclerosis (SSc). Among the information yet to be elucidated is whether anticentromere antibody (ACA) isotype levels can serve as biomarkers for future SSc development and for organ involvement. This study was undertaken to evaluate whether IgG, IgM, and IgA ACA levels in IgG ACA–positive patients are associated with disease severity and/or progression from very early SSc to definite SSc. Methods IgG ACA–positive patients from 5 different cohorts who had very early SSc or SSc fulfilling the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2013 criteria were included. A diagnosis of very early SSc was based on the presence of IgG ACAs and Raynaud’s phenomenon, and/or puffy fingers and/or abnormal nailfold capillaroscopy, but not fulfilling the ACR/EULAR 2013 criteria for SSc. Multivariable regression analyses were performed to determine the association between baseline ACA isotype levels and progression to definite SSc with organ involvement. Results Six hundred twenty‐five IgG ACA–positive patients were included, of whom 138 (22%) fulfilled the criteria for very early SSc and 487 (78%) had definite SSc. Levels of IgG ACAs (odds ratio 2.5 [95% confidence interval 1.8–3.7]) and IgM ACAs (odds ratio 1.8 [95% confidence interval 1.3–2.3]) were significantly higher in patients with definite SSc. Of 115 patients with very early SSc with follow‐up, progression to definite SSc occurred within 5 years in 48 (42%). Progression to definite SSc was associated with higher IgG ACA levels at baseline (odds ratio 4.3 [95% confidence interval 1.7–10.7]). Conclusion ACA isotype levels may serve as biomarkers to identify patients with very early SSc who are at risk for disease progression to definite SSc.
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Affiliation(s)
- Nina M van Leeuwen
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
| | - Maaike Boonstra
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
| | - Jaap A Bakker
- Leiden University Medical Centre, Department of Clinical Chemistry and Laboratory Medicine, Leiden, The Netherlands
| | - Annette Grummels
- Leiden University Medical Centre, Department of Clinical Chemistry and Laboratory Medicine, Leiden, The Netherlands
| | - Suzana Jordan
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - Sophie Liem
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
| | - Oliver Distler
- University Hospital Zurich, Department of Rheumatology, Zurich, Switzerland
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway, Rikshospitalet, Pb 4950 Nydalen, 0424, Oslo, Norway
| | - Karin Melsens
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | | | - Hans U Scherer
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
| | - René Toes
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
| | - Tom W J Huizinga
- Leiden University Medical Centre, Department of Rheumatology, Leiden, The Netherlands
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Nailfold videocapillaroscopic changes in patients with pulmonary arterial hypertension associated with connective tissue diseases. Rheumatol Int 2021; 41:1289-1298. [PMID: 33978819 DOI: 10.1007/s00296-021-04839-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/06/2021] [Indexed: 01/05/2023]
Abstract
Pulmonary arterial hypertension (PAH) represents one of the most devastating complications in connective tissue diseases (CTDs). The aim of this study was to investigate the presence of peripheral microangiopathy in patients with PAH associated with CTDs (CTD-PAH) by exploring nailfold videocapillaroscopic (NVC) changes and identify possible associations of NVC characteristics with markers of disease severity. Α cross-sectional study was performed in 18 CTD-PAH patients [13 PAH due to systemic sclerosis (SSc-PAH) and 5 with other types of CTD-PAH], 14 patients with SSc without PAH (SSc-non-PAH) and 20 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability, capillaroscopic images were reviewed by two independent investigators. When compared to healthy controls, patients with CTD-PAH (77.8% women, mean age 65.9 years) presented reduced capillary density (6.5 ± 1.6 loops/mm vs. 9.7 ± 0.7 loops/mm, p < 0.001) and increased capillary loop width (23.3 ± 10.1 μm vs. 11.2 ± 2.5 μm, p < 0.001). SSc-PAH patients presented lower capillary density in comparison with other CTD-PAH patients and SSc-non-PAH subjects and abnormal and disorganized capillaries compared to controls. Patients with other CTD-PAH had also reduced capillary density and increased loop diameter compared to controls. A significant linear correlation was identified between capillary density and estimated glomerular filtration rate in the total CTD-PAH population (r = 0.63, p = 0.007). In SSc-PAH group, capillary loop diameter was positively correlated to cardiac index (r = 0.61, p = 0.02). Significant NVC microvascular changes were detected in patients with various types of CTD-PAH, suggesting an impaired peripheral microcirculation parallel to pulmonary vasculopathy.
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Arslan NG, Pancar GS. Nailfold capillaroscopic changes of sleep apnea patients. Microvasc Res 2021; 137:104177. [PMID: 33984340 DOI: 10.1016/j.mvr.2021.104177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) have frequent association with comorbidities and this makes it an independent risk factor for cardiovascular disease. Not only endothelial dysfunction, but also arterial stiffening, increased inflammatory mediators, oxidative stress after hypoxemia that develops due to OSAS, cause vascular pathologies in all diameters of vessels. Nail bed capillaroscopy is a simple, noninvasive, useful method to examine microcirculation and evaluate nail bed capillary abnormalities in diseases that cause vascular damage. The aim of this study is to examine microvascular changes in the nail bed of OSAS patients by capillaroscopy. METHODS 59 OSAS patients and 60 healthy cases (totally 119) were included. One single attended polysomnography was applied with Embla N7000 series (RemLogic Eastmed, Natus); and apnea-hypopnea index (AHI), oxygen de-saturation index >4% (ODI4%), minimum oxygen saturation (SaO2 Min.), total duration of oxygen desaturation, comorbidities, body mass index (BMI), smoking habit, sleep questionnaire applications were analyzed. Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30) and all images were evaluated for capillary density, capillary loop enlargement, capillary tortuosity, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages. RESULTS The prevalence rates of all capillaroscopy findings were significantly higher in the patient group (p < 0.05). There was an inverse and moderate relationship between AHI and mean saturation (p < 0.05). A statistically significant correlation was detected between the presence of hypertension (HT) and the severity of capillary tortuosity (CT) (p = 0.002), avascular area (AA) (p = 0.004), and periungual cyanosis (PUC) (p = 0.042); also between smoking habit and intensity of capillary dilatation, enlargement dilatation-enlarged giant capillaries (CELON) (p = 0.004), CT (p = 0.018) findings. Capillary distribution (CD), CELON, CT and AA findings were significantly higher in the group with low mean saturation (p < 0.05). DM was found to be significantly higher in individuals with high Epworth Sleep Scale (ESS) (p = 0.035). CONCLUSION In this study; 1) the nail bed capillaroscopy was used to examine vascular damage in OSAS, and 2) irregularities detected in the distal nail bed specific to a disease have been mentioned for the first time. It has been shown that endothelial damage is particularly related to the severity of hypoxia. HT and smoking history causes endothelial damage independent of the severity of the disease and hypoxia. Also, ESS may be more determinant in the screening of sleep disorders in diabetic patients.
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Affiliation(s)
- Nevra Gullu Arslan
- Samsun Educational and Research Hospital, Department of Pulmonology, TR-55000 Samsun, Turkey.
| | - Gunseli Sefika Pancar
- Samsun Education and Research Hospital, Department of Dermatology, TR-55000 İlkadim, Samsun, Turkey
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Ruaro B, Confalonieri M, Salton F, Wade B, Baratella E, Geri P, Confalonieri P, Kodric M, Biolo M, Bruni C. The Relationship between Pulmonary Damage and Peripheral Vascular Manifestations in Systemic Sclerosis Patients. Pharmaceuticals (Basel) 2021; 14:403. [PMID: 33922710 PMCID: PMC8145021 DOI: 10.3390/ph14050403] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease, characterized by the presence of generalized vasculopathy and tissue fibrosis. Collagen vascular disorder in SSc is due to fibroblast and endothelial cell dysfunctions. This leads to collagen overproduction, vascular impairment and immune system abnormalities and, in the last stage, multi-organ damage. Thus, to avoid organ damage, which has a poor prognosis, all patients should be carefully evaluated and followed. This is particularly important in the initial disease phase, so as to facilitate early identification of any organ involvement and to allow for appropriate therapy. Pulmonary disease in SSc mainly involves interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). High-resolution computed tomography (HRCT) and pulmonary function tests (PFT) have been proposed to monitor parenchymal damage. Although transthoracic echocardiography is the most commonly used screening tool for PAH in SSc patients, definitive diagnosis necessitates confirmation by right heart catheterization (RHC). Moreover, some studies have demonstrated that nailfold videocapillaroscopy (NVC) provides an accurate evaluation of the microvascular damage in SSc and is able to predict internal organ involvement, such as lung impairment. This review provides an overview of the correlation between lung damage and microvascular involvement in SSc patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10126 Torino, Italy;
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy;
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Metka Kodric
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Marco Biolo
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50121 Florence, Italy;
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Abstract
Describing and listing all nail symptoms and signs in systemic disorders has already been widely detailed in dedicated textbooks. To be tutorial, this article described most common nails signs and the systemic disorders one may encounter in routine dermatologic consultation. Capsule summaries are presented for each section.
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Affiliation(s)
- Florence Dehavay
- Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Belgium
| | - Bertrand Richert
- Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Belgium.
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Schonenberg-Meinema D, Bergkamp SC, Nassar-Sheikh Rashid A, van der Aa LB, de Bree GJ, Ten Cate R, Cutolo M, Hak AE, Hissink Muller PC, van Onna M, Kuijpers TW, Smith V, van den Berg JM. Nailfold capillary abnormalities in childhood-onset systemic lupus erythematosus: a cross-sectional study compared with healthy controls. Lupus 2021; 30:818-827. [PMID: 33657918 PMCID: PMC8020305 DOI: 10.1177/0961203321998750] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES For selection of high-risk systemic lupus erythematosus (SLE) patients it is necessary to obtain indicators of disease severity that predict disease damage. As in systemic sclerosis, nailfold capillary abnormalities could be such a biomarker in SLE. The primary objective of this cross-sectional study is to describe capillary abnormalities in childhood-onset SLE (cSLE) cohort (onset < 18 years) and compare them with matched healthy controls. The secondary objective is to correlate the observed capillary abnormalities with demographical variables in both cohorts and with disease-specific variables in cSLE patients. METHODS Healthy controls were matched for ethnic background, age and gender. Videocapillaroscopy was performed in eight fingers with 2-4 images per finger. Quantitative and qualitative assessments of nailfold capillaroscopy images were performed according to the definitions of the EULAR study group on microcirculation in Rheumatic Diseases. RESULTS Both groups (n = 41 cSLE-patients and n = 41 healthy controls) were comparable for ethnic background (p = 0.317). Counted per mm, cSLE-patients showed significantly more 'giants' (p = 0.032), 'abnormal capillary shapes' (p = 0.003), 'large capillary hemorrhages' (p < 0.001) and 'pericapillary extravasations' (p < 0.001). Combined 'abnormal capillary shapes and pericapillary extravasations' (in the same finger) were detected in 78% (32/41 patients). By qualitative analysis, 'microangiopathy' was detected in 68.3% (28/41) and a 'scleroderma pattern' in 17.1% (7/41) of the cSLE-patients (without scleroderma symptoms). The difference of percentage positive anti-RNP antibodies in the group with or without a scleroderma pattern was not significant (p = 0.089). The number of 'abnormal capillary shapes per mm' was significantly correlated with treatment-naivety. The number of 'large pathological hemorrhages per mm' was significantly correlated with SLEDAI score and presence of nephritis. Compared to healthy controls, 'pericapillary extravasations' were found in significantly higher numbers per mm (p < 0.001) as well as in percentage of patients (p < 0.001). CONCLUSIONS Our observations confirm that giants, abnormal capillary morphology and capillary hemorrhages are also observed in cSLE, as was already known for adults with SLE. Number of capillary hemorrhages in cSLE was significantly correlated with disease activity. A high frequency and total amount of "pericapillary extravasations" was observed in cSLE patients, possibly revealing a new subtype of capillary hemorrhage that might reflect endothelial damage in these pediatric patients.
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Affiliation(s)
- Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Sandy C Bergkamp
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Amara Nassar-Sheikh Rashid
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Leontien B van der Aa
- Department of Pediatric Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Godelieve J de Bree
- Department of Infectious Diseases, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, the Netherlands
| | - Rebecca Ten Cate
- Department of Pediatric Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Maurizio Cutolo
- Department of Internal Medicine, Research Laboratory and Academic Division of Clinical Rheumatology, IRCCS Polyclinic San Martino Hospital, University of Genova, Genova, Italy
| | - A Elisabeth Hak
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Petra Ce Hissink Muller
- Department of Pediatric Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Marieke van Onna
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Belgium.,Faculty of Internal Medicine, Ghent University, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
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Arvanitaki A, Giannakoulas G, Triantafyllidou E, Feloukidis C, Boutou AK, Garyfallos A, Karvounis H, Dimitroulas T. Peripheral microangiopathy in precapillary pulmonary hypertension: a nailfold video capillaroscopy prospective study. Respir Res 2021; 22:27. [PMID: 33478514 PMCID: PMC7819216 DOI: 10.1186/s12931-021-01622-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity. Methods Α prospective case–control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal–Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test). Results Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 μm and 15.8 ± 1.9 μm vs. 11.5 ± 2.3 μm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001). Conclusion The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.
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Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.,Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Christos Feloukidis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
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Association of abdominal obesity with crossing capillaries in the finger nailfold in type 2 diabetes mellitus. Diabetol Int 2021; 12:260-267. [PMID: 34150434 DOI: 10.1007/s13340-020-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
Aim Increased crossing of finger nailfold capillaries could be a novel visual marker of early microvascular damage among type 2 diabetes mellitus patients. Although abdominal obesity is an important driver of early microvascular damage, its association with an increase in the percentage of crossing capillaries remains uncertain. We investigated the association between abdominal obesity and an increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus. Methods This cross-sectional study enrolled 123 type 2 diabetes mellitus patients (age 40-75 years) who visited the outpatient diabetic clinic at Osaka University Hospital between May and October 2019. Abdominal obesity was defined as a waist circumference ≥ 90 cm in women and ≥ 85 cm in men. Capillary morphology was assessed by nailfold capillaroscopy based on the simple capillaroscopic definitions of the European League Against Rheumatism Study Group. The association between abdominal obesity and a high percentage of crossing capillaries in the finger nailfold (defined as the highest tertile of crossing capillaries) was analyzed using multivariable logistic regression. Results After adjusting for age, sex, smoking status, regular exercise, duration of diabetes, glycated hemoglobin, hypertension, and dyslipidemia, abdominal obesity was significantly associated with a high percentage of crossing capillaries (multivariable-adjusted odds ratios [95% confidence interval] = 2.70 [1.05-6.90], p = 0.038). Conclusions Abdominal obesity may play an important role in the increase in the percentage of crossing capillaries in the finger nailfold in patients with type 2 diabetes mellitus.
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Herrick AL, Dinsdale G, Murray A. New perspectives in the imaging of Raynaud's phenomenon. Eur J Rheumatol 2020; 7:S212-S221. [PMID: 33164735 PMCID: PMC7647685 DOI: 10.5152/eurjrheum.2020.19124] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
The last 10-20 years have seen huge strides in imaging science. The aim of this review article is to share with the reader the key recent advances in non-invasive imaging of the digital (finger) vasculature in patients with Raynaud's phenomenon (RP), including in systemic sclerosis (SSc)-related digital vasculopathy. For the rheumatologist, seeing a patient with RP is an opportunity for early diagnosis of an underlying SSc-spectrum disorder or (conversely) for reassuring the patient with primary (idiopathic) RP. Non-invasive imaging techniques can help to provide diagnostic certainty. In addition, they can provide new insights into pathophysiology and have the potential to facilitate the development of much needed effective treatments by providing primary and secondary endpoints for randomized controlled trials: validation studies are ongoing. This review article focuses on nailfold capillaroscopy, thermography, and laser Doppler methods but also discusses (briefly) other technologies, including optical coherence tomography, multispectral imaging, and photoacoustic imaging. Key recent advances are the increasing use/availability of nailfold capillaroscopy (and better understanding of the role of low-cost hand-held devices), increased accessibility of thermography (including mobile phone thermography), and increased application of laser Doppler methods to the study of RP/digital vasculopathy (in particular of laser Doppler imaging and laser speckle contrast imaging, both of which measure blood flow over an area rather than at a single site). In an era of precision medicine, non-invasive imaging techniques can help stratify risk of (a) SSc in the patient with RP and (b) digital vascular disease progression in the patient with an SSc-spectrum disorder.
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Affiliation(s)
- Ariane L. Herrick
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Graham Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Andrea Murray
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
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Sugimoto T, Mokuda S, Yamaguchi K, Araki K, Kohno H, Yoshida Y, Hirata S, Hattori N, Sugiyama E. Rapid changes of nailfold capillary abnormalities during treatment for a patient with dermatomyositis complicated by lung cancer: a case report. Mod Rheumatol Case Rep 2020; 5:95-100. [PMID: 32985952 DOI: 10.1080/24725625.2020.1826650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nailfold capillary abnormalities are typically observed in patients with systemic sclerosis and are also often found in patients with polymyositis (PM) and dermatomyositis (DM). Nailfold capillary abnormalities in some patients with PM/DM were found to improve with immunosuppressant treatment. However, the short-term changes in nailfold capillaries and their associations with disease activity have not been established yet. Additionally, there have been no reports on whether nailfold capillary abnormalities can change during the progression of malignant tumours. A man in his 60s with anti-transcriptional intermediate factor 1γ (anti-TIF-1γ) antibody-positive DM complicated with small cell lung carcinoma was treated with prednisolone (PSL) 70 mg, carboplatin (CBDCA) and etoposide (VP-16). His nailfold capillary abnormalities improved rapidly, and the tumour size decreased with treatment. Although chemotherapy was continued, abnormalities in the nailfold capillaries gradually recurred. The worsening of the capillary abnormalities prompted us to examine computed tomography scans, which showed the recurrence of lung cancer. After switching to second-line chemotherapy, the change in the nailfold capillary abnormalities was again in a parallel course with the disease status of lung cancer. Changes in nailfold capillaries may be useful not only for the diagnosis but also for the evaluation of the recurrence of malignant tumours with DM.
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Affiliation(s)
- Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kei Araki
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroki Kohno
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
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May capillaroscopy be a candidate tool in future algorithms for SSC-ILD: Are we looking for the holy grail? A systematic review. Autoimmun Rev 2020; 19:102619. [DOI: 10.1016/j.autrev.2020.102619] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 01/03/2023]
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Sulli A, Paolino S, Pizzorni C, Ferrari G, Pacini G, Pesce G, Carmisciano L, Smith V, Cutolo M. Progression of nailfold capillaroscopic patterns and correlation with organ involvement in systemic sclerosis: a 12 year study. Rheumatology (Oxford) 2020; 59:1051-1058. [PMID: 31750929 DOI: 10.1093/rheumatology/kez374] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this observational study was to investigate the evolution of scleroderma microangiopathy throughout different nailfold videocapillaroscopy (NVC) patterns ('early', 'active', 'late') as well as the prevalence of organ involvement in SSc patients during a 12-year follow-up. METHODS Thirty-four SSc patients showing at baseline (first capillaroscopic analysis) the 'early' NVC pattern of microangiopathy were enrolled and followed for 12 years (s.d. 2). Complete NVC analysis and clinical and serological findings were collected. Patients were in a standard therapeutic care setting. Statistical analysis was carried out by non-parametric tests. RESULTS After a 12-year follow-up, the 'early' NVC pattern changed from baseline in 76% of the patients. The NVC pattern was found to be 'active' in 9 patients (26%), 'late' in 13 (38%) and characterized by non-specific capillary abnormalities in 4 (12%). In the subgroup whose microangiopathy progressed from the 'early' to the 'late' NVC pattern, the median time of progression from the 'early' to the 'active' pattern was significantly shorter (11 months) when compared with patients who progressed from the 'early' to the 'active' NVC pattern (55 months) (P = 0.002). The median time of progression between NVC patterns was significantly shorter in SSc patients showing either a nucleolar ANA pattern or Scl70 autoantibodies (P = 0.048). Organ involvement was progressively greater in SSc patients with 'early', 'active' and 'late' NVC patterns, respectively. CONCLUSIONS This longitudinal study confirms over a 12-year follow-up the evolution of specific NVC patterns associated with the progressive severity of organ involvement in SSc patients in a standard clinical care setting.
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Affiliation(s)
- A Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
| | - S Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
| | - C Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
| | - G Ferrari
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
| | - G Pacini
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
| | - G Pesce
- Laboratory for Autoimmunity, Department of Internal Medicine, University of Genova, IRCCS Ospedale Policlinico San Martino, Genova
| | - L Carmisciano
- Biostatistics Section, Department of Health Sciences, University of Genova, Genova, Italy
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, VIB Inflammation Research Centre - Ghent University, Ghent, Belgium
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine
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Pacini G, Paolino S, C Trombetta A, Goegan F, Pizzorni C, Alessandri E, Patanè M, Gotelli E, Ferrari G, Cattelan F, Ghio M, Casabella A, Smith V, Cutolo M. Lower urinary tract symptoms in systemic sclerosis: a detailed investigation. Rheumatology (Oxford) 2020; 59:1315-1324. [PMID: 31586421 DOI: 10.1093/rheumatology/kez438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/02/2019] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Urinary tract involvement is a seldom-reported manifestation of SSc that could compromise patients' quality of life. This study compares lower urinary tract symptoms (LUTS) in SSc patients and in healthy subjects and their association with clinical and diagnostic parameters. METHODS LUTS were assessed through self-reported questionnaires in 42 SSc patients and 50 matched healthy subjects. Statistical analyses were performed to explore LUTS in the two populations and their association with SSc variables, including nailfold videocapillaroscopy patterns, SSc-related antibodies and DXA parameters. RESULTS SSc patients showed significantly higher prevalence and severity of urinary incontinence (UI) and overactive bladder (OAB) than healthy controls (P < 0.005, P < 0.01). SSc was a strong predictor of LUTS, independent of demographic data, comorbidities and treatments (odds ratio 5.57, 95% CI 1.64-18.88). In SSc patients OAB positively correlated with sarcopenia (P < 0.001), and both OAB and UI significantly correlated with reduced BMD (P < 0.05, P = 0.001). UI positively correlated with Scl70 antibodies (P < 0.05) and ciclosporin treatment (P = 0.001) and negatively with RNA polymerase III antibodies (P < 0.05); OAB positively correlated with calcinosis (P < 0.005) and negatively with methotrexate treatment (P < 0.05). Nailfold videocapillaroscopy 'active' and 'late' patterns were predominant among SSc patients presenting urinary symptoms, although no statistical correlation was found. CONCLUSION For the first time urinary tract involvement was found to be significantly higher in SSc patients than in healthy matched controls. In addition, sarcopenia, bone damage and calcinosis appeared significantly correlated with LUTS, suggesting a possible interplay.
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Affiliation(s)
- Greta Pacini
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Amelia C Trombetta
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Federica Goegan
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Elisa Alessandri
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Massimo Patanè
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Emanuele Gotelli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Giorgia Ferrari
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Francesco Cattelan
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Massimo Ghio
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Andrea Casabella
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University.,Department of Rheumatology, Ghent University Hospital, Belgium Unit for Molecular Immunology and Inflammation.,VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genova, Italy
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Long F, He F, Wang J, Wang L, Tu J, Zhang Z, Xia J, Yin Z, Lu Y. Nailfold capillary abnormalities: a possible cause for nail psoriasis? Br J Dermatol 2020; 184:178-180. [PMID: 32767750 DOI: 10.1111/bjd.19466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/03/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- F Long
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - F He
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - J Wang
- Department of Rheumatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - L Wang
- Department of Rheumatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - J Tu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Z Zhang
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - J Xia
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Z Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Y Lu
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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48
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Jakhar D, Grover C, Singal A, Das GK. Nailfold Capillaroscopy and Retinal Findings in Patients with Systemic Sclerosis: Is There An Association? Indian Dermatol Online J 2020; 11:382-386. [PMID: 32695698 PMCID: PMC7367578 DOI: 10.4103/idoj.idoj_264_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction Systemic sclerosis (SSc) is characterized by fibrosis and intimal proliferation of cutaneous and visceral small vessels. These architectural abnormalities can be visualized with nailfold capillaroscopy (NFC); the changes being quite characteristic. At the same time, morphological alterations in retinal vascular bed are expected but sparsely described. Aim We aimed to characterize the frequency and type of retinal microvascular changes in patients with SSc and to analyze any association with NFC changes. Patients and Methods With institutional ethical committee approval, we recruited 45 consecutive patients with SSc (diagnosed based on American College of Rheumatology and European League against Rheumatism [ACR/EULAR-2013] criteria). NFC was done for all of them with a Universal Serial Bus (USB) dermatoscope; additionally, fundoscopy, fundus photography, and optical coherence tomography (OCT) were analyzed. Disease characteristics in patients with and without retinal disease were compared. Results Among the 45 SSc patients, 12 (26.67%) had limited cutaneous SSc (lSSc) while 33 (73.33%) had diffuse cutaneous disease (dSSc). Retinal microvascular changes seen as mild arteriolar alteration and arteriovenous crossing changes were recorded in 13 patients (28.89%); mostly in those with dSSc (12/13). The NFC architectural changes were more severe in patients with retinal disease, though the difference was not statistically significant. Conclusion Patients with SSc can often have retinal microvascular abnormalities commensurate with the vascular changes characteristic of SSc. The severity of retinal changes correlates with changes in NFC. NFC, which is now an essential tool for the management of SSc, could be a surrogate marker for retinal involvement in these patients.
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Affiliation(s)
- Deepak Jakhar
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - G K Das
- Department of Ophthalmology, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Mostmans Y, Richert B, Badot V, Nagant C, Smith V, Michel O. The importance of skin manifestations, serology and nailfold (video)capillaroscopy in morphea and systemic sclerosis: current understanding and new insights. J Eur Acad Dermatol Venereol 2020; 35:597-606. [PMID: 32656859 DOI: 10.1111/jdv.16813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/24/2020] [Indexed: 11/29/2022]
Abstract
Since the field around morphea and systemic sclerosis (SSc) is evolving rapidly, this review approaches conventional as well as more recent clinical developments from a dermatological point of view. Skin manifestations are critical in sub-classifying these diseases ensuring a correct prognosis for these patients. They can be discretely present, and therefore, diagnosis can be challenging sometimes, implicating a thorough dermatological examination is mandatory. Furthermore, a growing amount of dermatologists perform nailfold videocapillaroscopy (NVC), a more recent reliable non-invasive imaging technique used for in vivo assessment of the microcirculation at the nailfold. After all, specific NVC-changes are present in a majority of patients with SSc. This way, dermatologists not only take part in the diagnosis process through clinical investigation but also through the use of a modern state of the art imaging technique that is becoming the golden standard in SSc multidisciplinary workup. In this review, current understandings for NVC in morphea and SSc are revised. So far, the role of NVC in the diagnosis/prognosis/classification of morphea patients has not been thoroughly investigated to make proper conclusions. As for SSc, it is well known that NVC contributes to the diagnosis and can make a fundamental difference especially when obvious clinical SSc signs are absent. This review emphasizes the (somewhat underestimated) role of dermatologists in the process of diagnosis and follow-up, and thus, the difference we can make for our patients and fellow colleagues in the multidisciplinary workup of SSc and morphea.
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Affiliation(s)
- Y Mostmans
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - B Richert
- Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Badot
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Nagant
- Department of Immunology IRIS Laboratory, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, University Hospital (UZ) Ghent, Ghent, Belgium
| | - O Michel
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
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50
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Segmenting nailfold capillaries using an improved U-net network. Microvasc Res 2020; 130:104011. [DOI: 10.1016/j.mvr.2020.104011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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