Clinical significance of nailfold capillaroscopy in systemic lupus erythematosus: correlation with endothelial cell activation markers and disease activity

Abstract

Objective: To evaluate whether nailfold capillaroscopy (NC) changes are associated with the main serum endothelial cell activation markers and the disease activity of systemic lupus erythematosus (SLE).Methods: Serum levels of vascular endothelial growth factor (VEGF), endothelin‐1 (ET‐1), soluble E‐selectin (sE‐selectin), and soluble thrombomodulin (sTM) were determined by an enzyme‐linked immunosorbent assay (ELISA) in 80 SLE patients and 33 healthy controls.Results: Nailfold capillary abnormalities were seen in 74 out of 80 (92.5%) SLE patients. A normal capillaroscopic pattern or mild changes were found in 33 (41.25%) and moderate/severe abnormalities in 47 (58.75%) of all SLE patients. In SLE patients a capillaroscopic score >1 was more frequently associated with the presence of internal organ involvement (p<0.001) as well as with immunosuppressive therapy (p<0.01). Significant differences were found in VEGF (p<0.001), ET‐1 (p<0.001), sE‐selectin (p<0.01), and sTM (p<0.001) serum concentrations between SLE patients with a capillaroscopic score >1 and controls. SLE patients with severe/moderate capillaroscopic abnormalities showed significantly higher VEGF serum levels than patients with mild changes (p<0.001). Moreover, there was a significant positive correlation between the severity of capillaroscopic changes and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (p<0.005) as well as between capillaroscopic score and VEGF serum levels (p<0.001).Conclusions: Our findings confirm the usefulness of NC as a non‐invasive technique for the evaluation of microvascular involvement in SLE patients. A relationship between changes in NC, endothelial cell activation markers and clinical features of SLE suggest an important role for microvascular abnormalities in clinical manifestation of the disease.