Nail fold Capillaroscopic Findings in Iranian Patients with Systemic Lupus Erythematosus
Background: Systemic Lupus Erythematosus is a progressive autoimmune disease with a wide range of morphological and functional changes in microscopic examination of small blood vessels. Identification of vascular diseases at early stage, plays an essential role in the prevention of its’ vascular complications. Nailfold capillaroscopy (NFC) is a non-invasive, easy, painless, and accurate method for evaluation of microcirculation and could be used for this purpose. The vast majority of studies on capillaroscopy in lupus patients have shown that changes are not specified to lupus –unlike Systemic Sclerosis- and are more likely to overlap with other diseases. Therefore, it was decided to check capillaroscopic changes and evaluate morphological changes and capillary structure in terms of quality and quantity in lupus patients.
Materials and Methods: Nail fold capillaroscopic findings of 114 patients aged 19-75 years old were reviewed in this study. The results were categorized as: a) normal, b) non-specific morphological abnormalities, and c) Scleroderma-like pattern. Results were analyzed qualitatively and quantitatively using SPSS 21 software. "Chi square" test was used to analyze the relationships between variables (P<0.05 was considered significant).
Results: Our results show that Lupus –independent of any other microvascular risk factor can significantly affect the morphology and structure of blood circulation and these changes are shown with detail by nail fold capillaroscopy.
Conclusion: Most of the findings are in line with similar studies performed by other investigators in this field. However, no specific pattern was recognized and microbleeding was higher in our patients with scleroderma-like pattern of involvement.
Kuryliszyn A, Kliminuk P, Seirakowski S, Ciotkiowicz M. vascular endothelial growth factor in systemic lupus erythematosus: relationship to disease activity, systemic organ manifestation, and nailfold capillaroscopic abnormalities. Arch immunol Ther. 2006;55:179-85
Tibiriçá E, Rodrigues E, Cobas RA, Gomes MB. Endothelial Function in Patients with Type 1 Diabetes Evaluated by Skin Pillary Recruitment. Microvascular Research. 2007;73:107-12.
Kuryliszyn-Moskal A, Dubicki A, Zarzycki W, Zonnenberg A, Gorska M. Microvascular Abnormalities in Capillaroscopy Correlate with Higher Serum IL-18 and sE-Selectin Levels in Patients with Type 1 Diabetes Complicated by Microangiopathy. Folia histochemica et Cytobiologica/Polish Academy of Sciences. Polish Histochemical and Cytochemical Society. 2011;49:104-10.
Ingegnoli F, Gualtierotti R, Lubatti C, Bertolazzi C, Gutierrez M, Boracchi P, et al. Nailfold Capillary Patterns in Healthy Subjects: A Real Issue in Capillaroscopy. Microvascular Research. 2013;90:90-5.
Kaminska-Winciorek G, Deja G, Polanska J, Jarosz-Chobot P. Diabetic Microangiopathy in Capillaroscopic Examination of Juveniles with Diabetes Type 1. Postepy Higieny Medycyny Doswiadczalnej. 2012;66:51-9.
Bounameaux H, Miescher A, De Moerloose P. Association of anti cardiolipin antibodies and abnormal nailfold capillaroscopy in patients with systemic lupus erythematosus. Lupus. 1995 4. 142-144.
Lee P, Leung FY, Alderdice C, Armstrong SK. Naifold capillary Microscopy in the connective tissue diseases: a semiquantitative assessment. J Rheumatology. 1983;10:930-8.
Riccieri V, Spadaro A, Ce ccarelli F, Scrivo R, Germano V, Valesini G. Naifold capillaroscopy changes in systemic lupus erythematosus: correlations with disease activity and autoantibody Profile. Lupus. 2005;14:521-5.
Lambova SN, Hermann W, Muller-Ladner U. Comparison of Qualitative and Quantitative Analysis of Capillaroscopic Findings in Patients with Rheumatic Diseases. Rheumatology International. 2012;32:729-35.
Studer A, Hunziker T, Lutolfo, Schmidl J, chen D, Mahler F. quantitative nailfold capillary microscopy in cutaneous and systemic lupus erythematosus and localized and systemic scleroderma. J An Acad Dermatol. 1991;24:941-5.
Bongard O, Bounameaux H, Miescher PA, De Moerloose P. Association of anticardiolipin antibodies and abnormal naifold capillaroscopy inpatients with systematic lupus erythematosus. Lupus. 1995;4:142-4.
Furtado RNV, Pucinelli MLc, Cristo VV, Andrade LEC, Sato El. Selenoderma – like nailfold capillaroscopic abnormalities are associated with anti – U1 – RNP antibodies and Raynaud’s phenomenon In SLE patients. Lupus. 2002;11:35-41.
Maricq HR, Leroy EC, D’Angelo WA, et al. Diagnostic potential of in vivo capillary microscopy in scleroderma and related disorders. Arthritis Rheum 1980: 23: 183-188.
Kabasakal Y, Eluins Dm, Ring EFJ, Mc hugh NJ. Quantitative nailfold capillaroscopy finding in a population whit connective tissue disease and in normal health controls. Ann Rheum Dis. 1996;55:507-12.
Cutolo M, Pizzorni C, Tuccio M, Burroni A, Craviotto C, Basso M, et al. Nailfold Videocapillaroscopic Patterns and Serum Autoantibodies in Systemic Sclerosis. Rheumatology (Oxford). 2004;43:719-26.
Cutolo M. Atlas of Capillaroscopy. Walter Grassi, Patrizia Del Medico. 2004.
Cutolo M, Sulli A, Vanessa S. How to Perform and Interpret Capillaroscopy. Best Practice & Research Clinical Rheumatology. 2013;27:237-48.
Redish W, Messina EJ, Hughes G , McEwen C. Capillaroscopic observations in rheumatic diseases. Ann Rheum Dis. 1970;29:244-53
Lee p, leung FYK, Alderdice C, Armstrong SK. Nailfold capillary microscopy in mixed connective tissue diseases: a semiquantitative assessment . J Rheumatology. 1983;10:930-8
Granier F,Vayssairat M, Priollet P, Housset E. Nailfold capillary microscopy in mixed connective tissue disease.Arthritis Rheum. 1986;29:189-95
Pallis M, Hapkinson N, Pawell R. Nailfold capillary density as a possible indicator of pulmonary capillary loss in systemic lupus erythematosus but not in mixed connective tissue disease. J Rheumatol. 1991;18:1532-6
Kuryliszyn A. Clinical significance of nailfold capillaroscopy in systemic lupus erythematosus: correlation with endethelial cell activation markers and disease activity. Scand J Rheumatol. 2009;38(1):38-45.
Leroy Ec, Medsger TAJr. Criteria for the classification of early systemic sclerosis. J Rheumtol. 2001;18:1273-6.
Eredemier M, Xavier RM, capobinaco KG, et al. Nailfold capillary microscopy can suggest pulmunay disease activity in systemic sclerosis. J Rheumatol. 2004;31:286-94.
Sambataro E. Nailfold Videocapillaroscopy micro – hemorrhage and giant capillary counting as an accurate approach for a steady state definition of disease activity in systemic sclerosis, arthritis Research Therapy. 2014;16:462.