"Assessment of microvascular damage in sistemic sclerosis using nailfold capillaroscopy"

Author: Cumurciuc MihaiCo-author:Silvia Ioana Morar

Coordinator: Dr. Parvu Mirela

Background:Scleroderma is a connective tissue disease characterized

by fibrosis and degenerative lesions of the skin and internal organs

Excessive fibrosis is preceded by complex vascular structural and functional abnormalities and perivascular inflammation

Early in the disease,the peripheral microangiopathy may be well recognized and studied by nailfold capillaroscopy or better with the videocapillaroscopy, a non-invasive and safe technique , wich is well reported to have both diagnostic and prognostic .

ObjectiveThe aim of the study is to follow the nailfold video capillaroscopy effectiveness  in the diagnosis of patients with systemic sclerosis.

Material and Method:This study was performed on 10 patients admited  in the

Rheumatology Clinic of Targu Mures County Clinical Emergency Hospital;

Nailfold video capillaroscopy (NVC) was used to analyse microvascular abnormalities in patients with systemic sclerosis diagnosed according to ACR criteria.

Changes nailfold capillaries were evaluated by Videocap 3.0 magnification contact lenses 200 X;

Material and Method:Capillaroscopic examinations were performed at fingers

II-V on both hands in all patients. Microvascular damages were classified according to the Cutolo recomandations: -,,Early” -,,Active” - ,,Late” NVC pattern

Was made Anti Scl-70, Anti-centromer, Anti Ro-52 antibodies, performed by ELISA methode.

Results: The mean age of our SSc patients was 46,5 years old, predomining at females(ratio of F/M 9/1)

Presence of Antibodies:

Pathophysiology:The Pathophysiology of SSc involves vascular damage

and activation of fibroblast collagen and other extracellular proteins are overproduced in varios tissue;

The skin develops more compact collagen fibres in the reticular dermis ,epidermal thinning ,loss of rete pegs, and atrophy of dermal appendages;

In the nailfolds,capillary loops dilate and some microvascular loops are lost;

Raynaud’s Phenomenom

Raynaud’s phenomenom (RP) represent the most frequent clinical aspect of microvascular involvement and is a key feature of several autoimmune rheumatic diseases;

RP is associated in a statistically significant manner with many immune inflammatory diseases;

The ,,Scleroderma Pattern”The microvascular damage in SSc is mainly characterized by

increasing structural alterations of the capillaries with progressive decrease in their density;

Blood flow is also altered, with an average slowing of flow and increased periods of stasis;

In a recent study, microvascular alterations as detected by NVC in patients with SSc have been re-classified by Maurizio Cutolo in three different patterns:

-Early

-Active

-Late

M. Cutolo Atlas of Capillaroscopy in rheumatic diseases, Elsevier 2011

Type of NVC Pattern our patients:

The „Early” patternfew giants capillaries,few capillary microhaemorrhages, no evident loss of capillaries, and a relatively well-preserved capillary

distribution;

The „Active” pattern frequent giant capillaries, frequent capillary microhaemorrhages, moderate loss of capillaries, absence of or mildly ramified capillaries with slight disorganisation of the capillary architecture

The „Active” pattern

Anti-RO52 positive

Female, anti.SCl-70 > 8UI/ml

„Active/late” pattern

The „Late” Patternirregular, enlargement capillaries, almost absent giant capillaries and

microhaemorragessevere loss of capillaries with extensive

avascular areas, ramified/bushy capillaries,intensive disorganizations of the normal

array

The „Late” Pattern

resorbtion of distal phalanx

male, anti.SCl-70 = 80 UI/ml

female, anti.SCl-70 – 910 UI/ml

The „Active/Late” Pattern

Conclusions:Nailfold capillaroscopy represents the best ans safest method

for detecting and analysing microvascular abnormalities;

The early differential diagnosis between primary and secondary Raynaud’s phenomenom is the best advantage NVC may offer;

In future , the evaluation of nailfold capillaroscopy in autoimmune rheumatic diseases might represent a tool for prediction of microvascular heart involvement by considering the systemic microvascular derangement at the capillary nailfold;

Thank You