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Mahajan M, Kaur T, Singh K, Mahajan BB. Evaluation of nail fold capillaroscopy changes in patients with diabetic retinopathy and healthy controls, and its correlation with disease duration, HbA1c levels and severity of diabetic retinopathy: An observational study. Indian J Dermatol Venereol Leprol 2024; 0:1-7. [PMID: 38841954 DOI: 10.25259/ijdvl_232_2023] [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: 03/04/2023] [Accepted: 11/02/2023] [Indexed: 06/07/2024]
Abstract
Background Diabetic retinopathy (DR) is an important microvascular complication of long-term type 2 diabetes mellitus (T2DM) leading to blindness if not properly diagnosed and managed. It can develop as early as 7 years before the diagnosis of diabetes. Nail fold capillaroscopy (NFC) is a non-invasive technique for observing capillary microvasculature and there are few studies which have explored the use of NFC in diabetes mellitus patients. Objective To study the nail fold capillaroscopic alterations in patients with T2DM having diabetic retinopathy and compare them to healthy controls. The secondary objective was to correlate the NFC findings with the duration of diabetes, haemoglobin A1c (HbA1c) levels and the severity of DR. Materials and methods This cross-sectional observational study enrolled 200 patients - 100 cases with T2DM having diabetic retinopathy (as per the American Diabetes Association criteria and Diabetic Retinopathy Disease Severity Scale) and 100 healthy age and sex-matched controls. All patients were subjected to NFC and ophthalmological assessment. Results NFC revealed that patients with DR showed significantly higher frequencies of tortuous, dilated, bushy, meandering, angulated capillaries, avascular areas and micro-haemorrhages as compared to healthy controls (p < 0.05). In proliferative DR (PDR), the frequency of tortuous, bushy capillaries, and avascular areas was statistically high and the capillary density was reduced as compared to non-proliferative DR. The DR patients with longer disease duration (>20) years had a significantly higher frequency of tortuous capillaries, avascular areas, meandering, angulated and dilated capillaries. The frequency of tortuosity, avascular areas, and bushy areas was significantly higher in patients with poor glycaemic control (HbA1c >11). Limitations A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM patients with DR. Discussion NFC may act as a surrogate marker of retinal involvement in patients with DM and should be performed at regular intervals. Conclusion NFC is a quick, simple, safe, and non-invasive method to assess the capillaroscopic alterations in diabetic patients which inturn can help in assessing the severity of DR.
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Affiliation(s)
- Mohita Mahajan
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Amritsar, India
| | - Tejinder Kaur
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Amritsar, India
| | - Karamjit Singh
- Department of Ophthalmology, Government Medical College, Amritsar, India
| | - B B Mahajan
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Amritsar, India
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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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Lambova SN, Müller-Ladner U. "Scleroderma" and "Scleroderma-like" Capillaroscopic Pattern-Differences and Similarities. Curr Rheumatol Rev 2024; 20:304-316. [PMID: 38807470 DOI: 10.2174/0115733971265291231212045931] [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: 07/26/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 05/30/2024]
Abstract
INTRODUCTION The "scleroderma" type capillaroscopic pattern is a reference pattern in rheumatology that is a diagnostic sign for systemic sclerosis (SSc) in an appropriate clinical context and is observed in more than 90% of scleroderma patients. Similar microvascular changes, the so-called "scleroderma-like", have been described albeit in a lower proportion of patients with other rheumatic diseases, such as dermatomyositis (DM), undifferentiated connective tissue diseases (UCTD), systemic lupus erythematosus (SLE), etc. Three distinct stages of "scleroderma" pattern have been suggested by Cutolo et al., i.e., "early", "active", and "late". However, disease duration is just one of the factors that contributes to the progression of microvascular changes, and in this regard, "active" or even "late" pattern could be observed in patients with shorter disease duration. In addition, stable microvascular changes could be found for long periods in other cases. OBJECTIVE The aim of the study was to assess the presence of differentiating features between "scleroderma" pattern in SSc and "scleroderma-like" pattern in other rheumatic diseases. METHODS 684 capillaroscopic images demonstrating a "scleroderma" and "scleroderma-like" pattern have been analysed in the current retrospective cross-sectional study. 479 capillaroscopic pictures were obtained from 50 SSc patients, 105 from 7 DM patients, 38 from 10 rheumatoid arthritis (RA) patients, 36 images from 5 patients with SLE, and 26 images from 9 patients with UCTD. All capillaroscopic images used in the current analysis have fulfilled the criteria for "sclerderma/scleroderma-like" pattern, as the pathological changes in the capillaroscopic parameters have also been confirmed by quantitative measurement of capillary diameters, capillary density, and intercapillary distance. All the images have been categorized into one of the following groups, i.e., "early", "active" and "late" phases (according to the definition of Cutolo et al.), or "other" findings, the latter being specifically described as they could not be attributed to one of the other three categories. RESULTS 479 capillaroscopic pictures were obtained from 50 scleroderma patients. 31 of them showed an "early", 391 an "active" phase, and 57 a "late" phase "scleroderma" type microangiopathy. In 69 images assessed as an "active" pattern, neoangiogenesis was found. In 43 out of 105 capillaroscopic pictures from DM patients, an "active" phase was detected; in 2 of the images, a "late" pattern was found, and in 60 capillaroscopic pictures, neoangiogenesis in combination with giant capillary loops was observed. Early microangiopathy was not found in this group. Among capillaroscopic images from SLE patients, "late" phase microangiopathy was not found. "Early" phase was present in 3 images, "active" phase in 29, neoangiogenesis in "active" phase in 4 pictures. Early microangiopathy was detected in 11 capillaroscopic pictures from RA patients (8 out of 9 patients), an "active" phase in 4 images (3 patients), and in 23 capillaroscopic images, neoangiogenesis with mild capillary derangement and capillary loss and single giant capillaries ("rheumatoid neoangiogenic pattern") were observed. Classic "late" type microangiopathy was not found in RA patients as well as among patients with UCTD. The predominant capillaroscopic pattern in UCTD patients was early microangiopathy (n = 23). The rest images from UCTD exhibited features of the "active" phase. CONCLUSION In conclusion, early microangiopathy was observed in RA, SLE, and UCTD patients, but not in patients with DM. An "active" phase "scleroderma" type capillaroscopic pattern was detected in all patient groups other than SSc, i.e., DM, SLE, RA, and UCTD. "Late" phase "scleroderma" type microangiopathy was present in patients with scleroderma and DM and was not observed in SLE, RA, and UCTD. Despite the fact that in some cases, microangiopathy in scleroderma and other rheumatic diseases may be indistinguishable, the results of the current research have shown the presence of some differentiating features between "scleroderma" and "scleroderma-like" microangiopathy that might be a morphological phenomenon associated with differences in the pathogenesis and the degree of microvascular pathology in various rheumatic diseases.
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Affiliation(s)
- Sevdalina Nikolova Lambova
- Department of Propaedeutics of Internal Diseases "Prof Dr Anton Mitov", Faculty of Medicine, Medical University of Plovdiv, Bulgaria
- Department of Rheumatology, MHAT "Sveti Mina" Plovdiv, Bulgaria
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig University Giessen, Giessen, Germany
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Bad Nauheim, Germany
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Abhijit Desai S, Nayak CS. Nailfold capillaroscopy as a prognostic marker for connective tissue diseases: An observational clinico-epidemiological study. Indian J Dermatol Venereol Leprol 2023; 0:1-8. [PMID: 37317721 DOI: 10.25259/ijdvl_205_2022] [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: 02/23/2022] [Accepted: 12/11/2022] [Indexed: 06/16/2023]
Abstract
Background Nailfold capillaroscopy (NFC) is useful in the diagnosis and assessment of various connective tissue diseases. In this study, NFC findings were studied in patients of systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis. Aims To study the nailfold capillaroscopic findings in patients with connective tissue disorders, their correlation with disease severity, and changes in findings following treatment or disease progression. Methods This observational prospective time-bound clinico-epidemiological study was conducted in 43 patients over 20 months at Topiwala National Medical College and BYL Nair Ch. Hospital, Mumbai. NFC was performed using the polarising mode of a USB 2.0 video-dermatoscope in all 10 fingernails at 50X and 200X. It was repeated at three follow-up visits to look for changes in findings. Results Among SLE patients, eleven (52.4%) had non-specific NFC patterns and eight (38.1%) had SLE patterns. Among systemic sclerosis patients, eight (42.1%) cases had active and late SS patterns respectively, while one (5.3%) each had SLE, non-specific and early SS patterns. After three follow-ups, 10 out of 11 (90.9%) cases with improvement in NFC also showed clinical improvement; this figure was significantly more than 11 out of 23 (47.8%) cases who had no change in NFC but showed clinical improvement. Two of the three dermatomyositis patients showed a non-specific pattern while one showed a late SS pattern at baseline. Limitations A larger sample size would have yielded results with more validity. Standardisation of the interval between baseline and last follow-up to equal to or more than six months would have yielded results with more accuracy. Conclusion Capillary findings change significantly over time and reflect changes in the clinical status of patients of both SLE and systemic sclerosis, and hence are an important prognostic marker. Rather than an overt change in NFC pattern, reduction or increase in abnormal capillaries is a better predictor of change in disease activity.
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Affiliation(s)
- Saloni Abhijit Desai
- Department of Skin & V.D., TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Chitra S Nayak
- Department of Skin & V.D., TNMC & BYL Nair Ch. Hospital, Mumbai, Maharashtra, India
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Gumina S, Proietti R, Caccavale R, Paroli M, Preziosi Standoli J, Cantore M, Candela V. Peripheral microcirculation alteration as cause of posterosuperior rotator cuff tear: the possible indirect contribution of nailfold capillaroscopy. J Shoulder Elbow Surg 2023; 32:604-609. [PMID: 36183899 DOI: 10.1016/j.jse.2022.08.015] [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: 04/11/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most of the recent literature regarding rotator cuff tear etiology identifies in peripheral microcirculation disorders the probable main cause of tissue degeneration, and consequently of tendon rupture. Nailfold capillaroscopy is a practical and inexpensive diagnostic technique used to evaluate the health status of peripheral microcirculation, and recently, its use has found other indications in addition to that of diagnosing connective tissue diseases and Raynaud phenomenon. We verified the possible indirect contribution of nailfold capillaroscopy in the identification of peripheral microcirculation disturbances in a group of patients with rotator cuff tear and whether these possible alterations could be related to rotator cuff tear size. MATERIALS AND METHODS A case-control study was performed. One hundred patients (56 male, 44 female; mean age ± standard deviation [SD]: 60.46 ± 5.46 years) with different-sized posterosuperior cuff tears and 100 healthy controls (38 male, 62 female; mean age ± SD: 60.40 ± 6.34 years) were submitted to capillaroscopic examination. The following parameters were examined: capillary morphology and density, avascular areas, visibility of the subpapillary venous plexus, enlarged and giant capillaries, ectasias and microaneurysms, neoangiogenesis, hemosiderin deposits, pericapillary edema, and capillary blood flow. Severe exclusion criteria were applied. Statistical analysis was performed. RESULTS Visibility of subpapillary venous plexus (P < .001), pericapillary edema (P < .001), capillary blood flow (P < .001), ectasias and microaneurysms (P < .001), and neoangiogenesis (P = .04) were significantly associated with presence of a rotator cuff tear. CONCLUSIONS Our results support the hypothesis that microcirculation disorder has a relevant role in the genesis of cuff degeneration and, consequently, of tendon rupture. However, these alterations do not seem to be related to rotator cuff tear size.
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Affiliation(s)
- Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Rosalba Caccavale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Marino Paroli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | | | - Matteo Cantore
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, Rome, Italy; Istituto Clinico Ortopedico Traumatologico (ICOT), Latina, Italy.
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Microangiopathy in Rheumatic Diseases. Life (Basel) 2023; 13:life13020491. [PMID: 36836847 PMCID: PMC9965541 DOI: 10.3390/life13020491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
Capillaries are part of the microcirculation, which consists of arterioles, capillaries, and venules and are the connecting link between the arterial and venous blood circulation [...].
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Gorasiya AR, Mehta HH, Prakashey A, Dave M. Nailfold Capillaroscopy of Healthy Individuals - An Observational Study. Indian Dermatol Online J 2022; 13:600-605. [PMID: 36304665 PMCID: PMC9595142 DOI: 10.4103/idoj.idoj_80_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background Nailfold capillaroscopy (NFC) is a noninvasive quick method to visualize capillaries in the nailfold. There is paucity of these studies in healthy individuals in skin of color. Aim To evaluate the morphological characteristics and density of nailfold capillaries in healthy individuals. Settings and Design This observational cross-sectional study was conducted in the Department of Dermatology at a tertiary care hospital. About 150 healthy individuals by consecutive sampling were included in the study. Materials and Methods A total of 150 healthy individuals aged between 20 and 60 years were enrolled from January 2021 to September 2021 after consenting to the study protocol and qualifying the inclusion and exclusion criteria. NFC was performed for various morphological parameters and mean capillary density was also calculated. Comparison was done in male vs female, age group 20-40 vs 41-60, and body mass index (BMI) <24.9 vs >25. Statistical Analysis Different morphological parameters and capillary density were recorded and analyzed. The Mann-Whitney and Pearson's chi square was used according to type of data. Results The study observed tortuous capillaries (45.33%), meandering capillaries (44.66%), neoangiogenesis (38.66%), plexus visibility (36.66%), dilated capillaries (33.33%), receding capillaries (31.33%), angulated capillaries (14.66%), and ramified capillaries (6.6%). The study found significantly decreased plexus visibility in those with BMI > 25.Tortuous and receding capillaries were significantly increased in age group >40 years. Conclusion Various capillary morphological findings can be present in normal individuals but their presence in more number of fingers should be considered to be pathological. This data on normal morphology and capillary density add to the physiological NFC findings and thus aid in identifying the abnormalities.
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Affiliation(s)
- Amitkumar R. Gorasiya
- Department of Dermatology Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
| | - Hita H. Mehta
- Department of Dermatology Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
| | - Arjun Prakashey
- Department of Dermatology Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
| | - Manal Dave
- Department of Dermatology Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
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Calcutt JJ, Roberts MS, Anissimov YG. Predicting Viable Skin Concentration: Modelling the Subpapillary Plexus. Pharm Res 2022; 39:783-793. [PMID: 35266087 PMCID: PMC9090854 DOI: 10.1007/s11095-022-03215-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022]
Abstract
The skin concentration of a substance after a topical application or exposure determines both local treatment outcomes and the dermal toxicity assessment of various products. However, quantifying the time course of those concentrations at skin effect sites, such as the viable epidermal, superficial dermis and appendages in humans is especially problematic in vivo, making physiologically based mathematical modelling an essential tool to meet this need. This work further develops our published physiologically based pharmacokinetic and COMSOL based dermal transport modelling by considering the impact of the superficial subpapillary dermal plexus, which we represent as two well stirred compartments. The work also studied the impact on dermal concentrations of subpapillary plexus size, depth, blood velocity and density of subpapillary plexus vessels. Sensitivity analyses are used to define the most important transport determinants of skin concentrations after topical application of a substance, with previously published results used to validate the resulting analyses. This resulting model describes the available experimental data better than previous models, especially at deeper dermal depths.
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Affiliation(s)
- Joshua J Calcutt
- School of Environment and Science, Griffith University, Gold Coast, Queensland, 4222, Australia
| | - Michael S Roberts
- University of South Australia, Clinical Health Sciences and Basil Hetzel Institute for Translational Health Research, Adelaide, 5011, Australia
- Diamantina Institute, University of Queensland, Brisbane, 4072, Australia
| | - Yuri G Anissimov
- School of Environment and Science, Griffith University, Gold Coast, Queensland, 4222, Australia.
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Cao L, Wu Y, Huang Y, Li Z, Zhu J, Xu W, Xu L, Jiang Y, Yu L, Wang L. Nailfold capillaroscopy alterations in androgenetic alopecia: A cross-sectional study. Indian J Dermatol Venereol Leprol 2022; 88:781-787. [PMID: 35389034 DOI: 10.25259/ijdvl_714_2021] [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: 07/01/2021] [Accepted: 10/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Androgenetic alopecia is considered to be an independent predictor of mortality from diabetes mellitus and heart disease. However, whether androgenetic alopecia causes changes in microcirculation is unknown. OBJECTIVE The objective of the study was to investigate whether alterations in nailfold capillaries occur in androgenetic alopecia patients. METHODS The nailfold capillaroscopy images of androgenetic alopecia patients and matched controls were collected and analyzed. RESULTS The frequencies of avascular areas, dilated, bushy and bizarre capillaries and capillary disorganization, nailfold capillaroscopy scores of 2 or scores both 2 and 3 were significantly higher in the androgenetic alopecia group than in the healthy controls (9.0% vs. 0%, 57.7% vs. 19.2%, 3.8% vs. 0%, 2.8% vs. 1.3%, 3.8% vs. 0%, 38.5% vs. 12.8% and 39.7% vs. 12.8%, respectively). LIMITATIONS The results of this study may be biased on account of the limited sample size or the presence of an undiagnosed disease in participants which could alter the nailfold capillaries. CONCLUSION Bushy, bizarre and dilated capillaries, capillary disorganization, avascular areas and nailfold capillaroscopy scores of 2 or 2 and 3 were more common in androgenetic alopecia patients than in healthy controls. These findings indicate that abnormalities in microcirculation may be involved in androgenetic alopecia.
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Affiliation(s)
- Lei Cao
- Department of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi No.2 People's Hospital, Wuxi, Jiangsu, China
| | - Yajuan Wu
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Yuanbo Huang
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Zhongming Li
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Jing Zhu
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Wenrong Xu
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Lan Xu
- Endocrinology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Yanmin Jiang
- Endocrinology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Lu Yu
- Endocrinology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
| | - Lei Wang
- Departments of Dermatology and Venereology, Nanjing Medical University Affiliated Wuxi People's Hospital, Wuxi, Jiangsu, China
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Grover C, Jakhar D, Mishra A, Singal A. Nail-fold capillaroscopy for the dermatologists. Indian J Dermatol Venereol Leprol 2021; 88:300-312. [PMID: 34877857 DOI: 10.25259/ijdvl_514_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. The diagnostic utility of nail fold capillaroscopy has improved and expanded over the past couple of decades. Beyond connective tissue diseases, it is now explored for its role in various systemic and dermatological diseases. Incorporation of nail-fold capillaroscopy in the diagnostic criteria of systemic sclerosis has generated interest among dermatologists. The current review is aimed at providing knowledge about nail-fold capillaroscopy to dermatologists. For the purpose of review, a PubMed search was done using the keywords "nail fold capillaries" and "nail fold capillaroscopy". All the articles were retrieved and classified into reviews and clinical studies of various types. The final data were then analyzed and presented in a narrative fashion.
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Affiliation(s)
- Chander Grover
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
| | - Deepak Jakhar
- Department of Dermatology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Arzoo Mishra
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical College and GTB Hospital, New Delhi, India
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Pimenta da Fonseca E, Lins CF, de Sá Ribeiro DL, Santos WGD, Rosa G, Machicado V, Pedreira AL, Souza APMD, Baleeiro C, Dos Santos Ferreira LG, de Oliveira IS, da Silva JPCG, Atta AM, Santiago MB. Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy. J Clin Rheumatol 2021; 27:S198-S203. [PMID: 33337816 DOI: 10.1097/rhu.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without. METHODS Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test. RESULTS In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which "nonspecific changes" were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05). CONCLUSIONS The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ajax Merces Atta
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia
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Chanprapaph K, Fakprapai W, Limtong P, Suchonwanit P. Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls. Front Med (Lausanne) 2021; 8:683900. [PMID: 34422857 PMCID: PMC8377356 DOI: 10.3389/fmed.2021.683900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nailfold capillaroscopy (NFC) is a valuable tool to detect microcirculation abnormalities in connective tissue diseases (CTDs). However, whether the universal serial bus (USB) digital microscopy used as onychoscopy is as effective as the videocapillaroscopy in determining the diagnostic and prognostic values of CTDs remains to be determined. Objective: This study aims to investigate NFC features of systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc) patients and compare with normal controls as well as examine which feature could differentiate among CTDs. Furthermore, we aim to explore different capillaroscopic abnormalities and their association with disease activity. Methods: Nailfold images were taken from patients and healthy controls using a USB digital microscopy. Patterns on the capillary morphology, diameter, architecture, and density were recorded and compared. We further determined the NFC findings in SLE, DM, and SSc and corresponded to their respective disease activity scoring system. Results: A total of 245 participants, consisting of 54 SLE, 32 DM, and 51 SSc patients, as well as 108 controls, were enrolled. All capillaroscopic features, except for tortuous capillaries, were significantly more common in CTDs than healthy control (all p < 0.05). A multinomial logistic regression analysis revealed that bushy capillaries had significantly higher odds for both SLE and DM than SSc (OR: 4.10, 95% confidence interval (CI): 1.71-9.81, p = 0.002 and OR: 7.82, 95% CI, 2.86-21.38, p < 0.001, respectively). Elongated capillaries demonstrated significant odds for SLE compared with SSc (OR: 3.35, 95% CI: 1.005-11.20, p = 0.049), while prominent subpapillary plexus showed greater odds for SLE compared with both DM and SSc (OR: 2.75, 95% CI: 1.07-7.02, p = 0.03 and OR: 5.78, 95% CI: 2.29-14.58, p < 0.001, respectively). The presence of hemorrhage, enlarged capillaries, and the low-density index had significantly higher odds in favor of SSc than SLE. Bushy capillaries were the only pattern with a strong association for DM over SSc. The presence of enlarged capillaries indicated higher SLE severity, but no specific finding was related to DM or SSc skin scores. Conclusions: Nailfold capillaroscopic examination using a digital microscope is a valuable method for the diagnosis of SLE, DM, and SSc. Several morphologic patterns can help differentiate among CTDs; however, the prognostic significance of this method requires further investigations.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wuttidej Fakprapai
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeyachat Limtong
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Nailfold capillaroscopy changes associated with anti-RNP antibodies in systemic lupus erythematosus. Rheumatol Int 2021; 42:1355-1361. [PMID: 34076720 DOI: 10.1007/s00296-021-04894-4] [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: 02/25/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
Anti-U1RNP antibody is associated with distinct organ involvement in patients with systemic lupus erythematosus (SLE). Nailfold capillaroscopy (NFC) allows non-invasive assessment of microvascular abnormalities in several connective tissue diseases. The objective of this study is to determine the association of anti-U1RNP antibody with microvascular changes by NFC in RNP-positive SLE patients in comparison with RNP-negative SLE patients (negative disease controls) and mixed connective tissue disease (MCTD) cases (positive disease controls). NFC examination was performed in consecutive patients with SLE with or without anti-U1RNP positivity. MCTD patients were recruited as disease controls. Abnormalities noted in the three groups were compared using non-parametric tests. Ordinal logistic or linear regression was used wherever applicable. 81 patients were studied, of whom 28 were diagnosed as RNP-positive SLE (age 30.0 ± 10.37; 26 females), 26 were RNP-negative SLE (age 29.42 ± 9.20; 25 females) and 27 had MCTD (age36.5 ± 9.70; 25 females). RNP-positive SLE patients had more frequent giant capillaries, enlarged capillaries and ramified capillaries as compared to RNP-negative SLE (p = 0.05, < 0.01 and 0.03, respectively). The capillary density was lower in patients with MCTD as compared with patients with RNP-positive SLE (5.11 ± 1.69/mm vs 7.25 ± 1.38/ mm, p < 0.01) and RNP-negative SLE (8.92 ± 1.13/mm, p < 0.01). The reduction in capillary density was less severe in patients with RNP-negative SLE as compared with RNP-positive SLE (OR = 0.1058 [95% CI = 0.02-0.546], p < 0.01) which was independent of the presence of Raynaud's phenomenon, interstitial lung disease and disease duration. Presence of anti-U1RNP antibody is associated with notable patterns of microvascular abnormalities in SLE. These NFC abnormalities are noted more profoundly in patients with MCTD and are less marked in RNP-negative SLE patients.
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14
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Herrick AL, Berks M, Taylor CJ. Quantitative nailfold capillaroscopy-update and possible next steps. Rheumatology (Oxford) 2021; 60:2054-2065. [PMID: 33493310 DOI: 10.1093/rheumatology/keab006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 11/14/2022] Open
Abstract
We review the exciting potential (and challenges) of quantitative nailfold capillaroscopy, focusing on its role in systemic sclerosis. Quantifying abnormality, including automated analysis of nailfold images, overcomes the subjectivity of qualitative/descriptive image interpretation. First we consider the rationale for quantitative analysis, including the potential for precise discrimination between normal and abnormal capillaries and for reliable measurement of disease progression and treatment response. We discuss nailfold image acquisition and interpretation, and describe how early work on semi-quantitative and quantitative analysis paved the way for semi-automated and automated analysis. Measurement of red blood cell velocity is described briefly. Finally we give a personal view on 'next steps'. From a clinical perspective, increased uptake of nailfold capillaroscopy by general rheumatologists could be achieved via low-cost hand-held devices with cloud-based automated analysis. From a research perspective, automated analysis could facilitate large-scale prospective studies using capillaroscopic parameters as possible biomarkers of systemic sclerosis-spectrum disorders.
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Affiliation(s)
- Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - Chris J Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
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15
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Nailfold capillary changes in newly diagnosed hypertensive patients: An observational analytical study. Microvasc Res 2021; 136:104173. [PMID: 33895230 DOI: 10.1016/j.mvr.2021.104173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nail Fold capillaroscopy (NFC) is used to evaluate microvascular changes in the horizontally lying capillaries in the proximal nail fold. Arterial hypertension affects the microvascular beds producing structural changes. Our objective was to evaluate qualitative and quantitative NFC changes in newly diagnosed hypertensives as compared to age and sex matched normotensive controls and to determine association, if any, with microvascular changes visualized on fundoscopy. MATERIALS AND METHODS This observational, analytical study involved 41 newly diagnosed hypertensives (18-60 years) with 41 normotensive age and sex matched normotensive controls. The mean capillary density (MCD) and morphological changes were assessed for all, while fundoscopy was done for study group participants. The collected data was statistically analyzed. RESULTS The MCD in newly diagnosed hypertensives (5.21 ± 0.90 capillaries/mm) was significantly lower than normotensive controls (6.50 ± 0.65 capillaries/mm) (p < 0.001) in our study. Qualitative morphologic changes were more common in hypertensive patients including meandering capillaries, capillary dilation, avascular areas, bushy capillaries, and microhemorrhages (p value <0.001). Capillary disarray (73.17%) was a unique morphologic change seen significantly more commonly in study group (p < 0.001). Among hypertensives, MCD was lesser in patients with retinopathy (p = 0.125) and with microalbuminuria, while avascular areas and dilated capillaries were significantly more common. CONCLUSION Our study supports the role of NFC with USB dermatoscope in detecting unique microvascular morphological alterations in hypertensives, which were more frequent as well as distinctive, as compared to healthy controls. A good correlation with fundoscopic features and microalbuminuria suggests that it could be useful in predicting/detecting cardiovascular, or renal complications early, with an advantage of easy accessibility and repeatability.
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16
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Lambova SN. Nailfold Capillaroscopy - Practical Implications for Rheumatology Practice. Curr Rheumatol Rev 2021; 16:79-83. [PMID: 32423371 DOI: 10.2174/157339711602200415083444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sevdalina Nikolova Lambova
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Medical University - Plovdiv, Plovdiv, Bulgaria
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17
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Natalello G, De Luca G, Gigante L, Campochiaro C, De Lorenzis E, Verardi L, Paglionico A, Petricca L, Martone AM, Calvisi S, Ripa M, Cavalli G, Della-Torre E, Tresoldi M, Landi F, Bosello SL, Gremese E, Dagna L. Nailfold capillaroscopy findings in patients with coronavirus disease 2019: Broadening the spectrum of COVID-19 microvascular involvement. Microvasc Res 2021; 133:104071. [PMID: 32949574 PMCID: PMC7494493 DOI: 10.1016/j.mvr.2020.104071] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Increasing evidence points to endothelial dysfunction as a key pathophysiological factor in coronavirus disease-2019 (COVID-19). No specific methods have been identified to predict, detect and quantify the microvascular alterations during COVID-19. Our aim was to assess microvasculature through nailfold videocapillaroscopy (NVC) in COVID-19 patients. METHODS We performed NVC in patients with a confirmed diagnosis of COVID-19 pneumonia. Elementary alterations were reported for each finger according to a semi-quantitative score. Capillary density, number of enlarged and giant capillaries, number of micro-hemorrhages and micro-thrombosis (NEMO score) were registered. RESULTS We enrolled 82 patients (mean age 58.8 ± 13.2 years, male 68.3%) of whom 28 during the hospitalization and 54 after recovery and hospital discharge. At NVC examination we found abnormalities classifiable as non-specific pattern in 53 patients (64.6%). Common abnormalities were pericapillary edema (80.5%), enlarged capillaries (61.0%), sludge flow (53.7%), meandering capillaries and reduced capillary density (50.0%). No pictures suggestive of scleroderma pattern have been observed. Acute COVID-19 patients, compared to recovered patients, showed a higher prevalence of hemosiderin deposits as a result of micro-hemorrhages (P = .027) and micro-thrombosis (P < .016), sludge flow (P = .001), and pericapillary edema (P < .001), while recovered patients showed a higher prevalence of enlarged capillaries (P < .001), loss of capillaries (P = .002), meandering capillaries (P < .001), and empty dermal papillae (P = .006). CONCLUSION COVID-19 patients present microvascular abnormalities at NVC. Currently ill and recovered subjects are characterized by a different distribution of elementary capillaroscopic alterations, resembling acute and post-acute microvascular damage. Further studies are needed to assess the clinical relevance of NVC in COVID-19.
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Affiliation(s)
- Gerlando Natalello
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Gigante
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico De Lorenzis
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy; PhD program in Biomolecular Medicine - cycle XXXV, University of Verona, Italy
| | - Lucrezia Verardi
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria Paglionico
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Petricca
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Calvisi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Ripa
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Tresoldi
- General Medicine and Advanced Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Landi
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Laura Bosello
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Prencipe N, Scarati M, Manetta T, Berton AM, Parisi S, Bona C, Parasiliti-Caprino M, Ditto MC, Gasco V, Fusaro E, Grottoli S. Acromegaly and joint pain: is there something more? A cross-sectional study to evaluate rheumatic disorders in growth hormone secreting tumor patients. J Endocrinol Invest 2020; 43:1661-1667. [PMID: 32333332 DOI: 10.1007/s40618-020-01268-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to evaluate the rheumatic profile in acromegalic patients to better characterize joint pain. METHODS The immunological pattern (rheumatoid factor; antinuclear antibodies-ANA, extractable nuclear antigens-ENA-Ab; anti-citrullinated protein antibodies; erythrocyte sedimentation rate) was evaluated in 20 acromegaly subjects (AS) and 20 control subjects (CS). Bilateral joint ultrasound of hands/wrists and nail capillaroscopy were also performed. RESULTS Articular pain was more frequent in AS than in CS (p = 0.027). No difference was detected in immunological parameters. ANA and ENA-Ab were positive in only 10% of AS and in 5% of CS, while no difference was found in anti-citrullinated protein antibodies. No difference was detected between rheumatoid factor positivity, but threefold higher IgG were detected in AS compared to CS. The erythrocyte sedimentation rate was significantly higher in AS than CS (p = 0.040), while in AS, there was a trend in increased Power Doppler (PWD) articular uptake. The capillaroscopic evaluation showed a significant difference in almost each parameter (presence and number of tortuous capillaries, capillary enlargements, and hemorrhages), showing a moderate-to-severe microangiopathy in AS. CONCLUSION The results of our study suggest that joint damage in acromegaly has not an autoimmune etiology. Increased erythrocyte sedimentation rate levels and PWD alteration in acromegalic population reflect a possible inflammatory nature, while the capillaroscopic findings suggest a moderate-to-severe microangiopathy that could help to identify patients with a greater macroangiopathic risk.
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Affiliation(s)
- N Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - M Scarati
- SSD of Rheumatology, Medical Department, Mauriziano Hospital, Turin, Italy
| | - T Manetta
- Department of Public and Pediatric Health, AOU Health and Science City, Turin, Italy
| | - A M Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Parisi
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - C Bona
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Parasiliti-Caprino
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M C Ditto
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - V Gasco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Fusaro
- SC of Rheumatology, Medical Department, AOU Health and Science City, Turin, Italy
| | - S Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Science, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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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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Kroon S, Vorselaars VM, Hosman AE, Post MC, Snijder RJ, Mager JJ. Prevalence and diagnostic value of nail fold capillary microscopy in hereditary hemorrhagic telangiectasia: A retrospective study. Vasc Med 2020; 25:341-347. [PMID: 32303156 DOI: 10.1177/1358863x20910479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abnormal vasculature is a key feature of hereditary hemorrhagic telangiectasia (HHT) and can also present in the nail fold capillary beds. However, the exact prevalence and the clinical diagnostic value in HHT are still largely unknown. The nail fold can be easily and noninvasively inspected with a capillary microscope. We therefore retrospectively assessed the prevalence and diagnostic value of abnormal nail fold capillaries in all patients who were screened between January 2000 and July 2017 for the presence of HHT and underwent capillary microscopy in St Antonius Hospital, The Netherlands. Capillary microscopy results and clinical characteristics were extracted from medical files and the prevalence of abnormal nail fold capillaries was calculated and the diagnostic value of the Curaçao criteria with and without capillary microscopy results was assessed. Of the 1761 individuals screened, 923 (52%) were diagnosed with a clinical and/or genetic HHT diagnosis. In these patients, capillary microscopy was normal in 23% (n = 218), enlarged loops were seen in 11% (n = 99), and giant loops in 66% (n = 606). The sensitivity and specificity of the Curaçao criteria for the diagnosis of HHT without capillary microscopy results were 96% and 90%, respectively. The addition of the presence of giant loops to the Curaçao criteria led to a small increase in sensitivity to 97% without affecting the specificity. In conclusion, the prevalence of nail fold abnormalities in patients with HHT is high. Capillary microscopy can be a useful, easy, and noninvasive diagnostic tool in HHT.
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Affiliation(s)
- Steven Kroon
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Anna E Hosman
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Martijn C Post
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.,Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Repke J Snijder
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes J Mager
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
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21
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LAMBOVA SEVDALINANIKOLOVA. Scleroderma-like Pattern in Various Rheumatic Diseases. J Rheumatol 2020; 47:942. [DOI: 10.3899/jrheum.200020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Smith V, Herrick AL, Ingegnoli F, Damjanov N, De Angelis R, Denton CP, Distler O, Espejo K, Foeldvari I, Frech T, Garro B, Gutierrez M, Gyger G, Hachulla E, Hesselstrand R, Iagnocco A, Kayser C, Melsens K, Müller-Ladner U, Paolino S, Pizzorni C, Radic M, Riccieri V, Snow M, Stevens W, Sulli A, van Laar JM, Vonk MC, Vanhaecke A, Cutolo M. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev 2020; 19:102458. [DOI: 10.1016/j.autrev.2020.102458] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Grover C, Jakhar D, Singal A, Das G, Madhu SV. Nail fold capillaroscopic changes in patients with type 2 diabetes mellitus: An observational, comparative study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_146_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nailfold Capillaroscopy in Systemic Lupus Erythematosus (SLE): a Point-of-Care Tool That Parallels Disease Activity and Predicts Future Complications. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lambova SN, Müller-Ladner U. Nailfold capillaroscopy in systemic sclerosis - state of the art: The evolving knowledge about capillaroscopic abnormalities in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:200-211. [PMID: 35382505 PMCID: PMC8922564 DOI: 10.1177/2397198319833486] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/27/2019] [Indexed: 09/29/2023]
Abstract
Capillaroscopy is a unique method for morphological evaluation of the nailfold capillaries that plays a crucial role for early diagnosis of systemic sclerosis. The first description of the pathological capillaroscopic changes in systemic sclerosis was made by Brown and O'Leary in 1925. Several decades later they have been validated and accepted as a diagnostic criterion in the current 2013 EULAR/ACR classification criteria. This article summarizes the evolving knowledge about the use of nailfold capillaroscopy in systemic sclerosis. Initially, Maricq et al. suggested two major categories of capillaroscopic findings in systemic sclerosis - an 'active'and 'slow' capillaroscopic pattern. Their description and terminology suggested a correlation between capillaroscopic changes and disease activity and progression. In the later classification of Cutolo et al., three phases were defined, i.e. 'early', 'active' and 'late' that reflect the time-related evolution of the capillaroscopic changes suggesting their association with disease duration. Current knowledge about the microvascular changes in systemic sclerosis supports both associations with disease activity and disease duration. The general opinion about the association of capillaroscopic findings with clinical involvement and disease activity in systemic sclerosis is not uniform. This is supposedly because the phase changes of systemic sclerosis-related microangiopathy are almost a universal feature in scleroderma and are not specific for a certain type of an accompaning clinical manifestation. Thus, the speed of progression of microvascular alterations might be a decisive criterion, and in cases of rapid dynamics of capillaroscopic findings, it could be considered as an indicator of disease activity. Interestingly, vascular 'recovery' has been observed after treatment with immunosuppressive drugs, haematopoietic stem cell transplantation, and the endothelin receptor antagonist - bosentan. The evolving knowledge about nailfold capillaroscopy in systemic sclerosis will further spread its application from a mainly diagnostic tool to an established, reliable method for evaluation of disease activity, prognosis and therapeutic response.
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Affiliation(s)
- Sevdalina Nikolova Lambova
- Department of Propaedeutics of Internal Diseases, Faculty of Medicine, Medical University – Plovdiv, Plovdiv, Bulgaria
| | - Ulf Müller-Ladner
- Department for Internal Medicine and Rheumatology, Justus-Liebig University Giessen, Bad Nauheim, Germany
- Department for Rheumatology and Clinical Immunology, Campus Kerckhoff, Bad Nauheim, Germany
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Nailfold capillaroscopy and autoimmune connective tissue diseases in patients from a Portuguese nailfold capillaroscopy clinic. Rheumatol Int 2019; 40:295-301. [DOI: 10.1007/s00296-019-04427-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Fatemi A, Erlandsson BE, Emrani Z, Etehadtavakol M, Smiley A, Karbalaie A. Nailfold microvascular changes in patients with systemic lupus erythematosus and their associative factors. Microvasc Res 2019; 126:103910. [PMID: 31408627 DOI: 10.1016/j.mvr.2019.103910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/04/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine capillaroscopic changes in patients with systemic lupus erythematosus (SLE) and their predictors. METHODS Fifty-nine SLE patients and 31 controls were enrolled in a cross-sectional study. Nailfold capillaroscopy examinations were performed, and qualitative semi-quantitative and quantitative parameters were evaluated in all fingers. Demographic features and lupus characteristics, such as renal involvement, medications, laboratory data, disease activity (SLEDAI) and damage, were recorded. The predictors of capillaroscopic abnormalities were obtained by backward stepwise regression analysis. RESULTS Capillary numbers of right hands were significantly lower in patients than in controls [8.74 (1.66) vs. 9.63 (1.80), P = 0.0001]. Capillaries were wider in patients than in controls in right [56.32 μm (16.76) vs. 50.43 μm (10.16), P = 0.002] and left hands [54.40 (15.02) vs. 49.71 (9.77), P = 0.005]. Capillaries were shorter in SLE patients than in controls. Multivariate analysis revealed that the main associative factors of microvascular abnormalities were gender, drinking tea and hydroxychloroquine use for giant capillaries, SLEDAI and low C3 for avascularity and age, lupus nephritis and corticosteroid use for ramification. CONCLUSION Most nailfold capillaroscopic abnormalities were more common in SLE patients than in controls. Hydroxychloroquine, corticosteroids, SLEDAI, low complement and lupus nephritis may be the major prognostic factors for microvascular changes in SLE patients.
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Affiliation(s)
- Alimohammad Fatemi
- Rheumatology Section, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Björn-Erik Erlandsson
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Sweden.
| | - Zahra Emrani
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Etehadtavakol
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Abdolamir Karbalaie
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Sweden.
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Pan-American League of Associations for Rheumatology (PANLAR) capillaroscopy study group consensus for the format and content of the report in capillaroscopy in rheumatology. Clin Rheumatol 2019; 38:2327-2337. [DOI: 10.1007/s10067-019-04610-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/28/2022]
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Kayser C, Bredemeier M, Caleiro MT, Capobianco K, Fernandes TM, de Araújo Fontenele SM, Freire E, Lonzetti L, Miossi R, Sekiyama J, de Souza Müller C. Position article and guidelines 2018 recommendations of the Brazilian Society of Rheumatology for the indication, interpretation and performance of nailfold capillaroscopy. Adv Rheumatol 2019; 59:5. [PMID: 30670098 DOI: 10.1186/s42358-018-0046-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 12/20/2018] [Indexed: 12/22/2022] Open
Abstract
Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.
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Affiliation(s)
- Cristiane Kayser
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Botucatu 740, 3° andar, São Paulo, SP, 04023-062, Brazil.
| | - Markus Bredemeier
- Rheumatology Service, Hospital Nossa Senhora da Conceição, Grupo Hospitalar Conceição, Porto Alegre, RS, Brazil
| | - Maria Teresa Caleiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Karina Capobianco
- Rheumatology Service, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | | | - Eutilia Freire
- Rheumatology Service, Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Lilian Lonzetti
- Rheumatology Service, Complexo Hospitalar da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Renata Miossi
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Juliana Sekiyama
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Carolina de Souza Müller
- Rheumatology Division, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
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Mihai C, Smith V, Dobrota R, Gheorghiu AM, Cutolo M, Distler O. The emerging application of semi-quantitative and quantitative capillaroscopy in systemic sclerosis. Microvasc Res 2018; 118:113-120. [PMID: 29544760 DOI: 10.1016/j.mvr.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 12/23/2022]
Abstract
Systemic sclerosis (SSc) is a connective tissue disease with high morbidity and mortality, characterized by autoimmunity, obliterative vasculopathy involving mainly the microvasculature, and fibrosis. SSc-specific nailfold capillaroscopic changes have been defined, and nailfold capillaroscopy (NFC) is now unequivocally accepted to be a cornerstone for the early diagnosis of SSc. However, the use of NFC in patients already diagnosed with SSc is still not standardized. Several studies have shown that NFC abnormalities correlate with disease activity and severity and are predictive for disease worsening, such as occurrence of new digital ulcers. More importantly, successful treatment has been shown to diminish NFC abnormalities in severe SSc cases. These findings support the importance of NFC in monitoring patients with SSc and even its role as an outcome measure in SSc clinical trials. It is a matter of debate if Semi-quantitative and Quantitative NFC would be a more sensitive tool than qualitative NFC for meeting these objectives. This review is presenting the emerging application of Semi-quantitative and Quantitative NFC in SSc and its potential benefits.
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Affiliation(s)
- Carina Mihai
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Rucsandra Dobrota
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ana Maria Gheorghiu
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Cutolo M, Melsens K, Wijnant S, Ingegnoli F, Thevissen K, De Keyser F, Decuman S, Müller-Ladner U, Piette Y, Riccieri V, Ughi N, Vandecasteele E, Vanhaecke A, Smith V. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev 2018; 17:344-352. [PMID: 29427827 DOI: 10.1016/j.autrev.2017.11.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 01/03/2023]
Abstract
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Via Balbi 5, Genoa, Italy.
| | - Karin Melsens
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Sara Wijnant
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy.
| | - Kristof Thevissen
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Benekestraße 2-8, 61231 Bad Nauheim, Germany.
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialities, Sapienza University, Piazzale Aldo Moro 5, Rome, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy
| | - Els Vandecasteele
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
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Lambova SN. The Place of Nailfold Capillaroscopy Among Instrumental Methods for Assessment of Some Peripheral Ischaemic Syndromes in Rheumatology. Folia Med (Plovdiv) 2016; 58:77-88. [PMID: 27552783 DOI: 10.1515/folmed-2016-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/04/2016] [Indexed: 11/15/2022] Open
Abstract
Micro- and macrovascular pathology is a frequent finding in a number of common rheumatic diseases. Secondary Raynaud's phenomenon (RP) is among the most common symptoms in systemic sclerosis and several other systemic autoimmune diseases including a broad differential diagnosis. It should be also differential from other peripheral vascular syndromes such as embolism, thrombosis, etc., some of which lead to clinical manifestation of the blue toe syndrome. The current review discusses the instrumental methods for vascular assessments. Nailfold capillaroscopy is the only method among the imaging techniques that can be used for morphological assessment of the nutritive capillaries in the nailfold area. Laser-Doppler flowmetry and laser-Doppler imaging are methods for functional assessment of microcirculation, while thermography and plethysmography reflect both blood flow in peripheral arteries and microcirculation. Doppler ultrasound and angiography visualize peripheral arteries. The choice of the appropriate instrumental method is guided by the clinical presentation. The main role of capillaroscopy is to provide differential diagnosis between primary and secondary RP. In rheumatology, capillaroscopic changes in systemic sclerosis have been recently defined as diagnostic. The appearance of abnormal capillaroscopic pattern inherits high positive predictive value for the development of a connective tissue disease that is higher than the predictive value of antinuclear antibodies. In cases of abrupt onset of peripheral ischaemia, clinical signs of critical ischaemia, unilateral or lower limb involvement, Doppler ultrasound and angiography are indicated. The most common causes for such clinical picture that may be referred to rheumatologic consultation are the antiphospholipid syndrome, mimickers of vasculitides such as atherosclerosis with cholesterol emboli, and neoplasms.
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Affiliation(s)
- Sevdalina N Lambova
- Department of Propedeutics of Internal Medicine, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
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Riccieri V, Spadaro A, Ceccarelli F, Scrivo R, Germano V, Valesini G. Nailfold capillaroscopy changes in systemic lupus erythematosus: correlations with disease activity and autoantibody profile. Lupus 2016; 14:521-5. [PMID: 16130507 DOI: 10.1191/0961203305lu2151oa] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In systemic lupus erythematosus (SLE) nailfold capillaroscopy (NC) studies have described many different nonspecific patterns. We decided to evaluate NC changes in 44 SLE patients, comparing them with the main clinical, demographic and laboratory parameters, thus to define the real role for NC and its abnormalities in the management of this disease. Fifteen patients (34%) complained of Raynaud’s phenomenon; nine of them (20%) showed relevant capillaroscopic changes (capillaroscopic score >1). In details: three patients (6.8%) had loss of capillaries, while 18 (41%) had a capillary length variability, 16 (36.5%) showing shorter and two (4.5%) longer capillaries; tortuous, meandering, bizarre, ramified and/or bushy capillaries were found in 26 (59%), seven (16%), two (4.5%), three (7%) cases, respectively. An irregular distribution of the capillary array was present in six cases (14%) while microhaemorrhages were found in four cases (9%). 4 patients (9%) showed enlarged capillaries and changes of blood flow. A capillaroscopic score >1 was more frequently associated with higher ECLAM ( P < 0.005) and SLEDAI ( P < 0.01) activity scores, with the presence of anti-cardiolipin ( P < 0.04) and anti-Sm ( P < 0.04) antibodies, and also with the presence ( P < 0.04) and higher titer ( P < 0.001) of anti-dsDNA antibodies. No statistically significant correlation was found among the different capillaroscopy findings, age, disease duration, or treatment, nor with any clinical manifestation of the disease, such as cutaneous, renal or neurological. Our findings confirm the importance of the microvascular involvement in SLE. The NC abnormalities seem to be related to the disease activity and to the presence of many different antibodies, highly involved in the expression of SLE. NC proved to be an easy-to-perform noninvasive technique, able to achieve useful data to better evaluate such a pleomorphic disease as SLE.
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Affiliation(s)
- V Riccieri
- Cattedra di Reumatologia, Dipartimento di Clinica e Terapia Medica Applicata, Università "La Sapienza", Rome, Italy.
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Kubo S, Tanaka Y. Usefulness of nailfold videocapillaroscopy for systemic sclerosis. Inflamm Regen 2016; 36:5. [PMID: 29259678 PMCID: PMC5721719 DOI: 10.1186/s41232-016-0001-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/02/2016] [Indexed: 11/20/2022] Open
Abstract
Systemic sclerosis is a complex disease that involves “autoimmunity,” “inflammation,” “fibrosis,” and “vasculopathy.” Microvascular damage and dysfunction particularly represent the earliest morphological and functional markers of systemic sclerosis. These morphological changes and progressions can be detected by nailfold videocapillaroscopy (NVC). In 2013, the American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) proposed a new set of criteria for systemic sclerosis for the first time in 30 years. Items are given a weighted score, and a score more than 9 indicates systemic sclerosis. These classification criteria encompass a broader spectrum of systemic sclerosis patients including those with early stage and with excellent sensitivity and specificity. Notably, nailfold capillary abnormalities were one of the new items in the criteria. Moreover, these abnormalities are also markers of systemic sclerosis severity and progression, as reduced capillary density has been associated with a high risk of developing digital skin ulcers and pulmonary arterial hypertension. Since microvascular damage and dysfunction represent early markers of systemic sclerosis, qualitative and semi-quantitative assessment of videocapillaroscopy images is expected in clinical application and treatment outcome assessment. Despite the potential for targeted therapies in systemic sclerosis, there is no established therapy as yet. This may be due to several reasons. First, no fully validated outcome measures exist. Second, diagnosis of systemic sclerosis is often delayed and early intervention is difficult. Moreover, systemic sclerosis has clinical heterogeneity. Appropriate use of NVC helps to overcome these issues. Moreover, NVC may be useful in evaluating the pathogenesis of systemic sclerosis.
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Affiliation(s)
- Satoshi Kubo
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555 Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555 Japan
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Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, Distler O, Foeldvari I, Ingegnoli F, Müller-Ladner U, Riccieri V, Riemekasten G, Sulli A, Voskuyl A, Cutolo M. An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. Rheumatology (Oxford) 2016; 55:883-90. [PMID: 26843483 DOI: 10.1093/rheumatology/kev441] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability. METHODS The simple definitions proposed were: normal--hairpin, tortuous or crossing; abnormal--not hairpin, not tortuous and not crossing; not evaluable--whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. RESULTS Mean kappa based on 90 capillaries was 0.47 (95% CI: 0.39, 0.54) for expert raters, 0.40 (95% CI: 0.36, 0.44) for attendees and 0.46 (95% CI: 0.41, 0.52) for novices, with overall agreements of 67% (95% CI: 63, 71), 63% (95% CI: 60, 65) and 67% (95% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95% CI: 0.37 ,: 0.65), 0.53 (95% CI: 0.49, 0.58) and 0.55 (95% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95% CI: 0.74, 0.89) for novices (n = 44). CONCLUSION This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium,
| | - Sam Beeckman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saskia Decuman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, An der Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Milano, Italy
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, University Sapienza Rome, Rome, Italy
| | | | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
| | - Alexandre Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
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Etehad Tavakol M, Fatemi A, Karbalaie A, Emrani Z, Erlandsson BE. Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated? BIOMED RESEARCH INTERNATIONAL 2015; 2015:974530. [PMID: 26421308 PMCID: PMC4569783 DOI: 10.1155/2015/974530] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/25/2015] [Indexed: 11/18/2022]
Abstract
Video nailfold capillaroscopy (NFC), considered as an extension of the widefield technique, allows a more accurate measuring and storing of capillary data and a better defining, analyzing, and quantifying of capillary abnormalities. Capillaroscopic study is often performed on the patients suspected of having microcirculation problems such as Raynaud's phenomenon as the main indication for nailfold capillaroscopy. Capillaroscopic findings based on microcirculation studies can provide useful information in the fields of pathophysiology, differential diagnosis, and monitoring therapy. Nailfold capillaroscopy provides a vital assessment in clinical practices and research; for example, its reputation in the early diagnosis of systemic sclerosis is well established and it is also used as a classification criterion in this regard. This review focuses on the manner of performing video nailfold capillaroscopy and on a common approach for measuring capillary dimensions in fingers and toes.
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Affiliation(s)
- Mahnaz Etehad Tavakol
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan 81745-319, Iran
| | - Alimohammad Fatemi
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan 8174675731, Iran
| | - Abdolamir Karbalaie
- School of Technology and Health (STH), Royal Institute of Technology (KTH), 141 52 Huddinge, Sweden
| | - Zahra Emrani
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan 81745-319, Iran
| | - Björn-Erik Erlandsson
- School of Technology and Health (STH), Royal Institute of Technology (KTH), 141 52 Huddinge, Sweden
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Shenavandeh S, Zarei Nezhad M. Association of nailfold capillary changes with disease activity, clinical and laboratory findings in patients with dermatomyositis. Med J Islam Repub Iran 2015; 29:233. [PMID: 26793626 PMCID: PMC4715380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/11/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The present study aimed to investigate the Nailfold Capillaroscopy (NC) features of the patients with dermatomyositis (DM) and its correlation with their disease activity indices, physical findings, and laboratory results. METHODS The present cross-sectional study was conducted on 27 DM patients above 16 years old who had referred to an(there are 3 clinics not one) outpatient rheumatology clinics from 2012 to 2013. Nailfold capillaroscopy and calculation of disease activity indices were performed separately for all the patients by two rheumatologists who were blinded to each other's results. Statistical analyses were performed using chi-square and Mann-Whitney U tests. RESULTS The mean age of the patients was 39.2±14.1 years with the mean disease duration of 13.1±15.2 months (range: 1-72 months). Myopathic electromyography (EMG) findings showed a strong association with scleroderma pattern (p=0.015). However, disease activity in each organ system and global disease activity showed no significant association between scleroderma pattern and other NC findings. (Disease activity in each organ system and also global disease activity were both assessed to see if they are associated with scleroderma pattern and other NC findings so if we use between it means we are looking for an association between scleroderma pattern and other NC findings and this is not what we have done and is wrong.) CONCLUSION This study revealed no significant relationship between disease activity indices and NC features. Thus, it may be more precise to interpret the results of NC in conjunction with other physical and laboratory findings.
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Affiliation(s)
- Saeedeh Shenavandeh
- 1 MD, Assistant Professor, Department of Rheumatology, Shiraz Medical School, Shiraz University of Medical Sciences, Namazee Hospital Shiraz, Iran.
| | - Maryam Zarei Nezhad
- 2 MD, Rheumatology Fellow, Rheumatology Department, Namazee Hospital, Shiraz, Iran. ,(Corresponding author) MD, Rheumatology Fellow, Rheumatology Department, Namazee Hospital, Shiraz, Iran.
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Souza EJDRE, Kayser C. [Nailfold capillaroscopy: relevance to the practice of rheumatology]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:264-71. [PMID: 25440704 DOI: 10.1016/j.rbr.2014.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 09/04/2014] [Accepted: 09/14/2014] [Indexed: 12/13/2022] Open
Abstract
Nailfold capillaroscopy is a simple, low-cost method, that is extremely important in the evaluation of patients with Raynaud's phenomenon and of patients with systemic sclerosis (SSc) spectrum diseases. Besides its importance for the early diagnosis of SSc, nailfold capillaroscopy is a useful tool to identify scleroderma patients with high risk for development of vascular and visceral complications and death. The inclusion of capillaroscopy in the new classification criteria for SSc of the American College of Rheumatology (ACR) and European League Against Rheumatism (Eular) gives a new impetus to the use and dissemination of the method. In this paper, we present a didactic, non-systematic review on the subject, with emphasis on advances recently described.
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Affiliation(s)
- Eduardo José do Rosário E Souza
- Disciplina de Reumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil; Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Cristiane Kayser
- Disciplina de Reumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
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Nailfold capillaroscopy assessment in patients with glaucoma with a current optic disc hemorrhage. Can J Ophthalmol 2015; 50:155-8. [DOI: 10.1016/j.jcjo.2014.11.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/11/2014] [Accepted: 11/19/2014] [Indexed: 11/21/2022]
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Lee CB, Sung JH, Park JH, In Yoo C, Sim CS, Oh JS, Lee H. Nailfold capillary microscopy for evaluating hand-arm vibration syndrome. Ann Occup Environ Med 2014. [DOI: 10.1186/s40557-014-0027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Schlager O, Kiener HP, Stein L, Hofkirchner J, Zehetmayer S, Ristl R, Perkmann T, Smolen JS, Koppensteiner R, Gschwandtner ME. Associations of nailfold capillary abnormalities and immunological markers in early Raynaud’s phenomenon. Scand J Rheumatol 2014; 43:226-33. [DOI: 10.3109/03009742.2013.847118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Subhash HM, Leahy MJ. Microcirculation imaging based on full-range high-speed spectral domain correlation mapping optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:21103. [PMID: 23807553 DOI: 10.1117/1.jbo.19.2.021103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Microcirculation imaging is a key parameter for studying the pathophysiological processes of various disease conditions, in both clinical and fundamental research. A full-range spectral-domain correlation mapping optical coherence tomography (cm-OCT) method to obtain a complex-conjugate-free, full-range depth-resolved microcirculation map is presented. The proposed system is based on a high-speed spectrometer at 91 kHz with a modified scanning protocol to achieve higher acquisition speed to render cm-OCT images with high-speed and wide scan range. The mirror image elimination is based on linear phase modulation of B-frames by introducing a slight off-set of the probe beam with respect to the lateral scanning fast mirror's pivot axis. An algorithm that exploits the Hilbert transform to obtain a complex-conjugate-free image in conjunction with the cm-OCT algorithm is used to obtain full-range imaging of microcirculation within tissue beds in vivo. The estimated sensitivity of the system was around 105 dB near the zero-delay line with ∼20 dB roll-off from ±0.5 to ±3 mm imaging-depth position. The estimated axial and lateral resolutions are ∼12 and ∼30 μm, respectively. A direct consequence of this complex conjugate artifact elimination is the enhanced flow imaging sensitivity for deep tissue imaging application by imaging through the most sensitive zero-delay line and doubling the imaging range.
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Affiliation(s)
- Hrebesh M Subhash
- National University of Ireland, Tissue Optics and Microcirculation Imaging Facility, National Biophotonics and Imaging Platform, University Road, Galway, Ireland.
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Lambova SN, Müller-Ladner U. The specificity of capillaroscopic pattern in connective autoimmune diseases. A comparison with microvascular changes in diseases of social importance: arterial hypertension and diabetes mellitus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0221-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Ingegnoli F, Gualtierotti R, Lubatti C, Bertolazzi C, Gutierrez M, Boracchi P, Fornili M, De Angelis R. Nailfold capillary patterns in healthy subjects: a real issue in capillaroscopy. Microvasc Res 2013; 90:90-5. [PMID: 23880032 DOI: 10.1016/j.mvr.2013.07.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 06/10/2013] [Accepted: 07/04/2013] [Indexed: 12/22/2022]
Abstract
Nailfold capillaroscopy has been extensively applied in a broad spectrum of pathologic conditions, but very few data have been published in healthy individuals. The aim of this study was to describe the nailfold capillary findings on a large series of healthy subjects using the video-capillaroscopy technique. Nailfold capillaries were studied based on their morphology, dimensions and density. Then, to evaluate jointly the association between different capillary findings in groups of subjects which were homogeneous for their characteristics, cluster analysis was performed. The results (median) of capillary measurements were as follows: loop length 207μm, external diameter 39μm, internal diameter 17μm, apical diameter 17μm, and intercapillary distance 143μm. Based on the cluster analysis three major "normal" morphologic capillaroscopic patterns were depicted: 1) the "normal" pattern mainly with 2 to 5 U-shaped loops/mm and ≤2 tortuous loops/mm; 2) the "perfect normal" pattern with ≥5 U-shaped loops/mm and 3) the "unusual normal" with at least 1 meandering or bushy loop, or at least 1 microhemorrhage, or with >4 crossed loops/mm. Regarding the loop measurements, the majority of subjects had a median of 7capillaries/mm with a median length of 198μm.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Italy
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Lopez V, Chamoux A, Tempier M, Thiel H, Ughetto S, Trousselard M, Naughton G, Dutheil F. The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation: a cross-sectional study 15 years after retirement. BMJ Open 2013; 3:bmjopen-2013-002785. [PMID: 23794583 PMCID: PMC3686170 DOI: 10.1136/bmjopen-2013-002785] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To assess residual long-term microcirculation abnormalities by capillaroscopy, 15 years after retiring from occupational exposure to vinyl chloride monomer (VCM). DESIGN Cross-sectional study. SETTING Allier, one of the major areas of polyvinyl chloride production in France. PARTICIPANTS We screened 761 (97% men) retired workers exposed to chemical toxics. Exposure to chemicals other than VCM excluded potential participants. PRIMARY AND SECONDARY OUTCOME MEASURES These participants underwent a medical examination including a capillaroscopy, symptoms of Raynaud and comorbidities, as well as a survey to determine exposure time, direct or indirect contact, type of occupation, smoking status and time after exposure. A double blind analysis of capillaroscopic images was carried out. A control group was matched in age, sex, type of occupation. RESULTS 179/761 retired workers were only exposed to VCM at their work, with 21 meeting the inclusion criteria and included. Exposure time was 29.8±1.9 years and time after exposure was 15.9±2.4 years. Retired workers previously exposed to VCM had significantly higher capillaroscopic modifications than the 35 controls: enlarged capillaries (19% vs 0%, p<0.001), dystrophy (28.6% vs 0%, p=0.0012) and augmented length (33% vs 0%, p<0.001). Time exposure was linked (p<0.001) with enlarged capillaries (R(2)=0.63), dystrophy (R(2)=0.51) and capillary length (R(2)=0.36). They also had higher symptoms of Raynaud (19% vs 0%, p=0.007) without correlation with capillaroscopic modifications. CONCLUSIONS Although VCM exposure was already known to affect microcirculation, our study demonstrates residual long-term abnormalities following an average of 15 years' retirement, with a time-related exposure response. Symptoms of Raynaud, although statistically associated with exposure, were not related to capillaroscopic modifications; its origin remains to be determined.
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Affiliation(s)
- Vincent Lopez
- Department of Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | - Alain Chamoux
- Department of Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | - Marion Tempier
- Department of Radiopharmacy, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | - Hélène Thiel
- Department of Vascular Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | - Sylvie Ughetto
- Department of Medical Information—Clinical research and innovation direction, University Hospital CHU G. Montpied, Clermont-Ferrand, France
| | - Marion Trousselard
- Neurophysiology of emotions, ENOP Department, CRSSA/IRBA, La Tronche, France
| | - Geraldine Naughton
- School of Exercise Science, Australian Catholic University, Fitzroy, Australia
| | - Frédéric Dutheil
- Department of Occupational Medicine, University Hospital CHU G. Montpied, Clermont-Ferrand, France
- School of Exercise Science, Australian Catholic University, Fitzroy, Australia
- Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological conditions (AME2P, EA3533), Blaise Pascal University, Clermont-Ferrand, France
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Rossi D, Russo A, Manna E, Binello G, Baldovino S, Sciascia S, Roccatello D. The role of nail-videocapillaroscopy in early diagnosis of scleroderma. Autoimmun Rev 2012; 12:821-5. [PMID: 23219768 DOI: 10.1016/j.autrev.2012.11.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Raynaud's phenomenon (RP) is a clinical sign of precocious abnormal microcirculation and can be considered a major risk factor for the development of connective tissue disease, especially systemic sclerosis (SSc). Nailfold videocapillaroscopy is the most valuable tool for the early diagnosis of SSc and related disorders. It allows classification of capillary abnormalities. Scoring capillaroscopic alterations, which change significantly during patient follow-up, should be systematically used in order to monitor microangiopathy. The effectiveness of the nailfold videocapillaroscopy in allowing an early diagnosis of SSc and monitoring the progression of the disease, and its predictive value of clinical complications make it a powerful tool for clinical evaluation and research.
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Affiliation(s)
- Daniela Rossi
- Department of Rare, Immunologic, Hematologic Diseases and Transfusion Medicine, Research Center of Immunopathology and Rare Diseases (CMID), Giovanni Bosco Hospital and University of Turin, Italy.
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Wu PC, Huang MN, Kuo YM, Hsieh SC, Yu CL. Clinical applicability of quantitative nailfold capillaroscopy in differential diagnosis of connective tissue diseases with Raynaud's phenomenon. J Formos Med Assoc 2012; 112:482-8. [PMID: 24016612 DOI: 10.1016/j.jfma.2012.02.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 02/23/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Nailfold capillaroscopy is a useful tool to distinguish primary from secondary Raynaud's phenomenon (RP) by examining the morphology of nailfold capillaries but its role in disease diagnosis is not clearly established. The purpose of this study was to evaluate the roles of quantitative nailfold capillaroscopy in differential diagnosis of connective tissue diseases (CTDs) with RP. METHODS The data between the year 2005 and 2009 were retrieved from the nailfold capillaroscopic database of National Taiwan University Hospital (NTUH). Only the data from the patients with RP were analyzed. The criteria for interpretation of capillaroscopic findings were predefined. The final diagnoses of the patients were based on the American College of Rheumatology classification criteria for individual diseases, independent of nailfold capillaroscopic findings. The sensitivity and the specificity of each capillaroscopic pattern to the diseases were determined. RESULTS The data from a total of 67 patients were qualified for the current study. We found the sensitivity and specificity of scleroderma pattern for systemic sclerosis (SSc) were 89.47% and 80%, and the specificity of the early, active, and late scleroderma patterns for SSc reached 87.5%, 97.5%, and 95%, respectively. The sensitivity/specificity of systemic lupus erythematosus (SLE) pattern for SLE and polymyositis/dermatomyositis (PM/DM) pattern for PM/DM were 33.33%/95.45% and 60%/96.3%, respectively. The sensitivity/specificity of mixed connective tissue disease (MCTD) pattern for MCTD were 20%/100%. CONCLUSION The nailfold capillaroscopic (NC) patterns may be useful in the differential diagnosis of CTDs with RP. The NC patterns for SSc and PM/DM are both sensitive and specific to the diseases, while the SLE and MCTD patterns exhibit high specificity but relatively low sensitivity.
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Affiliation(s)
- Po-Chang Wu
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Pavlov-Dolijanovic S, Damjanov NS, Vujasinovic Stupar NZ, Marcetic DR, Sefik-Bukilica MN, Petrovic RR. Is there a difference in systemic lupus erythematosus with and without Raynaud’s phenomenon? Rheumatol Int 2012; 33:859-65. [DOI: 10.1007/s00296-012-2449-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 05/06/2012] [Indexed: 11/30/2022]
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Goffredo M, Schmid M, Conforto S, Amorosi B, D’Alessio T, Palma C. Quantitative color analysis for capillaroscopy image segmentation. Med Biol Eng Comput 2012; 50:567-74. [DOI: 10.1007/s11517-012-0907-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 04/10/2012] [Indexed: 11/29/2022]
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