Association of nailfold capillaroscopic findings with clinical features in patients with systemic sclerosis
DOI:
https://doi.org/10.3329/bsmmuj.v17i1.71879Keywords:
systemic sclerosis, nailfold capillaroscopy, disease duration, interstitial lung diseaseAbstract
Background: Microvascular damage is one of the most important etiopathogenetic and clinical characteristics of systemic sclerosis (SSc). Nailfold capillaroscopy (NFC) is a simple, non-invasive, and inexpensive imaging technique to assess the skin microcirculation. The aim of this study was to determine the association between NFC findings and clinical features in patients with SSc.
Methods: This study was done in the Department of Rheumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from July 2019 to August 2020. Twenty-nine adult patients with SSc were selected according to ACR/EULAR (American College of Rheumatology/European Alliance of Associations for Rheumatology) criteria 2013. NFC variables (capillary loss, avascular area, giant capillary, microhemorrhage and neoangiogenesis) and their NFC patterns (nonspecific, early, active, and late scleroderma) were analyzed using a dynamic nailfold capillaroscope. Their associations with disease duration, skin thickness score, interstitial lung disease (ILD), pulmonary hypertension (PH) and peripheral vascular involvement (pitting scar, and others) were examined.
Results: Among 29 patients, scleroderma patterns were present in 27 (93.1%) patients. Thirteen (44.8%) patients had late scleroderma pattern. Early scleroderma pattern and active scleroderma patterns were observed in 7 (24.1%) patients. Disease duration was significantly associated with avascular area (P=0.04) and NFC pattern (P=0.001). Microhemorrhage was significantly associated (P=0.04) with PH, but NFC pattern was associated with ILD (P=0.03).
Conclusion: NFC pattern found to be significantly associated with disease duration and ILD. Among the individual NFC findings, avascular area shows association with disease duration and microhaemorrhage showed association with pulmonary hypertension in SSc patients.
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References
Caramaschi P, Canestrini S, Martinelli N, Volpe A, Pieropan S, Ferrari M. Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Rheumatology. 2007 Aug 27;46(10):1566–9. DOI: https://dx.doi.org/10.1093/rheumatology/kem190.
Pizzorni C, Sulli A, Smith V, Lladó A, Paolino S, Cutolo M, Ruaro B. Capillaroscopy 2016: new perspectives in systemic sclerosis. Acta Reumatol Port. 2016 Jan-Mar;41(1):8-14. English. PMID: 27115103.
Ingegnoli F, Gualtierotti R. A systematic overview on the use and relevance of capillaroscopy in systemic sclerosis. Expert Rev Clin Immunol. 2013 Nov;9(11):1091-7. DOI: https://dx.doi.org/10.1586/1744666X.2013.849198.
Ghizzoni C, Sebastiani M, Manfredi A, Campomori F, Colaci M, Giuggioli D, Ferri C. Prevalence and evolution of scleroderma pattern at nailfold videocapillaroscopy in systemic sclerosis patients: Clinical and prognostic implications. Microvasc Res. 2015 May;99:92-5. DOI: https://dx.doi.org/10.1016/j.mvr.2015.03.005.
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 Jan 22;59(1):5. DOI: https://dx.doi.org/10.1186/s42358-018-0046-4.
Castellví I, Simeón-Aznar CP, Sarmiento M, Fortuna A, Mayos M, Geli C, Diaz-Torné C, Moya P, De Llobet JM, Casademont J. Association between nailfold capillaroscopy findings and pulmonary function tests in patients with systemic sclerosis. J Rheumatol. 2015 Feb;42(2):222-7. DOI: https://dx.doi.org/10.3899/jrheum.140276.
Smith V, Thevissen K, Trombetta AC, Pizzorni C, Ruaro B, Piette Y, Paolino S, De Keyser F, Sulli A, Melsens K, Cutolo M; EULAR Study Group on Microcirculation in Rheumatic Diseases. Nailfold Capillaroscopy and Clinical Applications in Systemic Sclerosis. Microcirculation. 2016 Jul;23(5):364-72. DOI: https://dx.doi.org/10.1111/micc.12281.
Herrick AL, Cutolo M. Clinical implications from capillaroscopic analysis in patients with Raynaud’s phenomenon and systemic sclerosis. Arthritis Rheum. 2010 May 5;62(9):2595–604. DOI: https://dx.doi.org/10.1002/art.27543.
Marino Claverie L, Knobel E, Takashima L, Techera L, Oliver M, Gonzalez P, Romanini FE, Fonseca ML, Mamani MN. Organ involvement in Argentinian systemic sclerosis patients with "late" pattern as compared to patients with "early/active" pattern by nailfold capillaroscopy. Clin Rheumatol. 2013 Jun;32(6):839-43. doi: 10.1007/s10067-013-2204-8. DOI: https://dx.doi.org/10.1007/s10067-013-2204-8.
Lovy M, Mac-Carter D, Steigerwald JC. Relationship between nailfold capillary abnormalities and organ involvement in systemic sclerosis. Arthritis Rheum. 1985 May;28(5):496–501. DOI: http://dx.doi.org/10.1002/art.1780280505.
Cutolo M, Pizzorni C, Tuccio M, Burroni A, Craviotto C, Basso M, Seriolo B, Sulli A. Nailfold videocapillaroscopic patterns and serum autoantibodies in systemic sclerosis. Rheumatology (Oxford). 2004 Jun;43(6):719-26. DOI: https://dx.doi.org/10.1093/rheumatology/keh156.
Lambova S, Müller-Ladner U. Capillaroscopic Findings in Systemic Sclerosis -- Are They Associated with Disease Duration and Presence of Digital Ulcers? Discov Med. 2011; 12(66): 413-418. PMID: 22127112.
Ingegnoli F, Ardoino I, Boracchi P, Cutolo M, EUSTAR co-authors. Nailfold capillaroscopy in systemic sclerosis: data from the eular scleroderma trials and research (EUSTAR) registry. Microvasc Res. 2013;89: 122-128. DOI: https://doi.org/10.1016/j.mvr.2013.06.003.
Alivernini S, De Santis M, Tolusso B, Mannocci A, Bosello SL, Peluso G, Pinnelli M, D'Antona G, La Torre G, Ferraccioli G. Skin ulcers in systemic sclerosis: determinants of presence and predictive factors of healing. J Am Acad Dermatol. 2009 Mar;60(3):426-35. DOI: https://dx.doi.org/10.1016/j.jaad.2008.11.025.
Sebastiani M, Manfredi A, Colaci M, D'amico R, Malagoli V, Giuggioli D, Ferri C. Capillaroscopic skin ulcer risk index: a new prognostic tool for digital skin ulcer development in 1. systemic sclerosis patients. Arthritis Rheum. 2009 May 15;61(5):688-94. DOI: shttps://dx.doi.org/10.1002/art.24394.
Silva I, Teixeira A, Oliveira J, Almeida I, Almeida R, Águas A, Vasconcelos C. Endothelial Dysfunction and Nailfold Videocapillaroscopy Pattern as Predictors of Digital Ulcers in Systemic Sclerosis: a Cohort Study and Review of the Literature. Clin Rev Allergy Immunol. 2015 Oct;49(2):240-52. DOI: shttps://dx.doi.org/10.1007/s12016-015-8500-0.
Cutolo M, Herrick AL, Distler O, Becker MO, Beltran E, Carpentier P, Ferri C, Inanç M, Vlachoyiannopoulos P, Chadha-Boreham H, Cottreel E, Pfister T, Rosenberg D, Torres JV, Smith V; CAP Study Investigators. Nailfold Videocapillaroscopic Features and Other Clinical Risk Factors for Digital Ulcers in Systemic Sclerosis: A Multicenter, Prospective Cohort Study. Arthritis Rheumatol. 2016 Oct;68(10):2527-39. DOI: shttps://dx.doi.org/10.1002/art.39718.
Avouac J, Lepri G, Smith V, Toniolo E, Hurabielle C, Vallet A, Amrouche F, Kahan A, Cutolo M, Allanore Y. Sequential nailfold videocapillaroscopy examinations have responsiveness to detect organ progression in systemic sclerosis. Semin Arthritis Rheum. 2017 Aug;47(1):86-94. DOI: http://dx.doi.org/10.1016/j.semarthrit.2017.02.006.
Hofstee HM, Vonk Noordegraaf A, Voskuyl AE, Dijkmans BA, Postmus PE, Smulders YM, Serné EH. Nailfold capillary density is associated with the presence and severity of pulmonary arterial hypertension in systemic sclerosis. Ann Rheum Dis. 2009 Feb;68(2):191-5. DOI: http://dx.doi.org/10.1136/ard.2007.087353.
Soulaidopoulos S, Triantafyllidou E, Garyfallos A, Kitas GD, Dimitroulas T. The role of nailfold capillaroscopy in the assessment of internal organ involvement in systemic sclerosis: A critical review. Autoimmun Rev. 2017 Aug;16(8):787-795. DOI: http://dx.doi.org/10.1016/j.autrev.2017.05.019.
Sato LT, Kayser C, Andrade LE. Nailfold capillaroscopy abnormalities correlate with cutaneous and visceral involvement in systemic sclerosis patients. Acta Reumatol Port. 2009 Apr-Jun;34(2A):219-27. PMID: 19474777.
Shenavandeh S, Haghighi MY, Nazarinia MA. Nailfold digital capillaroscopic findings in patients with diffuse and limited cutaneous systemic sclerosis. Reumatologia. 2017;55(1):15-23. DOI: https://dx.doi.org/10.5114/reum.2017.66683.
Molberg Ø, Hoffmann-Vold AM. Interstitial lung disease in systemic sclerosis: progress in screening and early diagnosis. Curr Opin Rheumatol. 2016 Nov;28(6):613-8. DOI: https://doi.org/10.1097/BOR.0000000000000323.
Khanna D, Furst DE, Clements PJ, Allanore Y, Baron M, Czirjak L, Distler O, Foeldvari I, Kuwana M, Matucci-Cerinic M, Mayes M, Medsger T Jr, Merkel PA, Pope JE, Seibold JR, Steen V, Stevens W, Denton CP. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. J Scleroderma Relat Disord. 2017 Jan-Apr;2(1):11-18. DOI: https://doi.org/10.5301/jsrd.5000231.
Matucci-Cerinic M, Steen V, Nash P, Hachulla E. The complexity of managing systemic sclerosis: screening and diagnosis. Rheumatology. 2009;48(suppl_3): iii8-iii13. DOI: https://doi.org/10.1093/rheumatology/ken482.
Smith V, Riccieri V, Pizzorni C, Decuman S, Deschepper E, Bonroy C, Sulli A, Piette Y, De Keyser F, Cutolo M. Nailfold capillaroscopy for prediction of novel future severe organ involvement in systemic sclerosis. J Rheumatol. 2013 Dec;40(12):2023-8. DOI: https://doi.org/10.3899/jrheum.130528.
Jehangir M, Qayoom S, Jeelani S, Yousuf R. Nail fold capillaroscopy in patients of systemic sclerosis and its association with disease severity as evidenced by high resolution computed tomography lung: a hospital based cross sectional study. Int J Res Med Sci. 2015: 3485-3489. DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20151223.
Smith V, Decuman S, Sulli A, Bonroy C, Piettte Y, Deschepper E, de Keyser F, Cutolo M. Do worsening scleroderma capillaroscopic patterns predict future severe organ involvement? a pilot study. Ann Rheum Dis. 2012 Oct;71(10):1636-9. DOI: https://doi.org/10.1136/annrheumdis-2011-200780.
Kim H, Park M, Kim H, Park S. Capillary dimension measured by computer-based digitalized image correlated with plasma endothelin-1 levels in patients with systemic sclerosis. Clin Rheumatol. 2010;29(3):247-254. https://doi.org/10.1007/s10067-009-1288-7.
Ohtsuka T, Hasegawa A, Nakano A, Yamakage A, Yamaguchi M, Miyachi Y. Nailfold capillary abnormality and pulmonary hypertension in systemic sclerosis. Int J Dermatol. 1997;36(2):116-122. DOI: https://doi.org/10.1046/j.1365-4362.1997.00088.x.
Fichel F, Baudot N, Gaitz J, Trad S, Barbe C, Francès C, Senet P. Systemic Sclerosis with Normal or Nonspecific Nailfold Capillaroscopy. Dermatology. 2014;228(4):360-367. DOI: https://doi.org/10.1159/000360159.
Ong YY, Nikoloutsopoulos T, Bond CP, Smith MD, Ahern MJ, Roberts-Thomson PJ. Decreased nailfold capillary density in limited scleroderma with pulmonary hypertension. Asian Pac J Allergy Immunol. 1998 Jun-Sep;16(2-3):81-6. PMID: 9876945.
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Copyright (c) 2024 Tajkia Haque, Md. Abu Shahin, Md. Ariful Islam, Iftekhar Hussain Bandhan, Minhaj Rahim Choudhury, Syed Atiqul Haq, Mohammad Mostafa Zaman
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