Re-evaluation of nailfold capillaroscopy in discriminating primary from secondary Raynaud's phenomenon and in predicting systemic sclerosis: a randomised observational prospective cohort study

BACKGROUND

Primary Raynaud's phenomenon (pRP) is difficult to distinguish from secondary (sRP). Although nailfold capillaroscopy (NFC) may detect early alterations, no universal criteria yet discriminate between pRP from sRP.

OBJECTIVES

To create and validate two NFC scores that could distinguish pRP from sRP and that could predict systemic sclerosis (SSc), respectively.

METHODS

We performed NFC on two separate cohorts with isolated RP, and recorded number of capillaries per field, enlarged/giant capillaries, crossed/bizarre patterns, microhemorrhages, neoangiogenesis, rarefaction, edema, blood flow velocity, stasis. By multivariate regression analysis, we evaluated the adjusted prognostic role of these features in a derivation cohort of 656 patients. Results were used to construct algorithm-based prognostic scores (A and B). These scores were then tested on a confirmation cohort of 219 patients.

RESULTS

Score A was unable to discriminate sRP from pRP (low negative predictive values with high positive predictive values for any cut-point); score B was unable to discriminate progression to SSc or a SSc-spectrum disorder (low positive predictive values with high negative predictive values for lower cut-points).

CONCLUSION

NFC patterns, believed as specific, showed low discriminatory power and on their own are unable to reliably discriminate sRP from pRP or predict evolution to SSc.

Effect of rutin on polymorphonuclear leukocytes oxidative metabolism in hypercholesterolemic Golden Syrian hamsters: evaluation by chemiluminescence and flow cytometry

Atherosclerosis has been described as an inflammatory disease in which polymorphonuclear leukocytes (PMNLs) seem to be involved. These cells may induce atherosclerotic lesions by releasing reactive oxygen species (ROS) and a sort of pro-inflammatory mediators. In this study, the PMNL oxidative metabolic status of Golden Syrian hamsters fed a normal diet (ND), or a high-fat diet (10% coconut oil plus 0.2% cholesterol) supplemented (R-HCD) or not (HCD) with 0.1% (w/w) rutin was evaluated after 120 days of treatment. PMNL oxidative metabolism was assessed by whole blood luminol-enhanced chemiluminescence and 2',7'-dichlorofluorescein diacetate-dependent flow cytometry. The results obtained by both methods were similar and showed no significant changes in ROS generation by PMNLs in blood samples from HCD or R-HCD animals when compared to ND. Furthermore it was shown that rutin supplementation did not significantly affect plasma lipid and lipoprotein levels in the hypercholesterolemic animals characterized by significantly increased total plasma cholesterol, triglycerides and low- and high-density lipoprotein cholesterol levels. The results suggest that in this model atherosclerosis development is not related to circulating PMNL activation and rutin supplementation has no immunomodulatory or hypocholesterolemic effects.