Capillaroscopic pattern in systemic lupus erythematosus and undifferentiated connective tissue disease: What we still have to learn?

Abstract

In rheumatology, specific is the capillaroscopic pattern in systemic sclerosis (SSc), the so-called "scleroderma type". Capillaroscopic pattern in systemic lupus erythematosus (SLE) is less specific and includes a wide range of microvascular changes-"SLE-type" capillaroscopic pattern, non-specific findings and in a small percentage "scleroderma-like" pattern. The latter finding is currently associated with a potential subclinical overlap with SSc. Various microvascular changes have been observed in a different proportion of patients with undifferentiated connective tissue disease (UCTD). The aim of the study was to evaluate the capillaroscopic changes in SLE and UCTD. Patients from the following groups were included in the study: 30 female patients with SLE (mean age, 49 ± 15.4 years), 31 patients with UCTD (mean age, 50 ± 17 years; 30 females and 1 male); 34 age- and sex-matched healthy volunteers were examined as a control group. Nailfold capillaroscopy was performed using videocapillaroscope Videocap 3.0 (DS Medica). Capillaroscopic findings were compared with clinical and laboratory data of the patients. At capillaroscopic examination, the most frequent capillaroscopic changes in SLE patients were the presence of elongated capillaries in 43 % (13/30), an increased tortuosity in 70 % (21/30) and a prominent subpapillary plexus in 60 % (18/30) of the cases. In 80 % (24/30) of the patients, dilated capillaries were found; in 6.6 % (2/30), giant capillary loops; and in 16.6 % (5/30), haemorrhages. In 50 % of the patients, an "SLE-type" capillaroscopic pattern was found. In 30 % (9/30) of the cases the capillaroscopic examination revealed "non-specific changes", in 6.6 % (2/30) of the patients it was found a normal capillaroscopic pattern and in 13.3 % (4/30) a "scleroderma-like" pattern. Positive tests for ANA were detected in 73.3 % (11/15) of the patients with "SLE-type" capillaroscopic pattern. In all the patients with "scleroderma-like" capillaroscopic finding, positive autoantibodies with a high titre were found, without signs for overlap with other connective tissue disease (CTD). In two out of four patients with such capillaroscopic findings, a vasculitis of peripheral vessels was evident and in the other two secondary RP and high immunologic activity. A "scleroderma-like" pattern was found in 38 % (12/31) of the patients with UCTD. In 51 % (16/31) of the patients from this group, "non-specific" capillaroscopic findings were observed. For the evaluation of the predictive value of capillaroscopic pattern for the development of a distinct rheumatic disorder in patients with UCTD, a longer period of follow-up is necessary. In SLE patients, it has been found that capillaroscopic examination reveals microvascular changes also in the absence of RP. Here, the results from the study illustrate the correlation between capillaroscopic changes and immunological profile. "Scleroderma-like" capillaroscopic pattern may be observed in the context of active vasculitis of peripheral vessels as well as in patients with secondary RP and high immunologic activity. It does not have an obligatory association with an overlap syndrome with other CTD. Capillaroscopic findings in UCTD are heterogeneous. The potential of capillaroscopic examination in UCTD for evaluating the prognosis of the disease needs to be revealed through long-term follow-up.