Study of the association between nailfold capillaroscopic changes and serum level of interleukin-17 in rheumatoid: a clue for emerging vaculitis

H K Koryem,Omneya E Elazzay,M Y Tayel,S S Eltawab,R F Moftah

doi:10.4103/1110-161x.192254

H K Koryem, Omneya E Elazzay + Show 3 more

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https://doi.org/10.4103/1110-161x.192254

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Abstract

The aim of this work was to study nailfold capillaroscopic (NC) abnormalities and serum interleukin-17 (IL-17) level among rheumatoid arthritis (RA) patients and to find whether IL-17 is causally involved in the changes in the capillary vascular bed, such as autoimmune prevasculitic changes. The study was conducted on a group of RA Egyptian patients (n=40) who were diagnosed as having RA based on ACR criteria. Those 40 patients were further divided into two groups. Group 1 included RA patients with clinical signs of skin vasculitis and NC changes (n=6). Group 2 included RA patients with no clinical signs of skin vasculitis and no NC changes (n=34). All patients were subjected to demographic data collection, clinical examination, disease activity score 28 calculation, laboratory measurement (including erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, antinuclear antibody, antineutrophil cytoplasmic antibody, anti-cyclic citrullinated peptide, and IL-17) andNCexamination. Inaddition, group 1 (n=6) was further subjected to electrophysiological evaluation using peripheral nerve conduction studies to determine the effect of vasculitis on the peripheral nerves. IL-17 level and NC changes showed a significant association in RA vasculitis patients. Elevated levels of serum IL-17 and characteristic NC changes raise their importance in the detection of preclinical rheumatoid vasculitis.

Highlights

Rheumatoid vasculitis (RV) is the most serious systemic disease manifestation of rheumatoid arthritis (RA), wherein it manifests almost exclusively in RA patients with rheumatoid autoantibodies and often occurs in the context of other extra-articular manifestations
All patients were subjected to demographic data collection, historical data, clinical examination, calculation of disease activity score 28 (DAS 28), laboratory measurement [including erythrocyte sedimentation rate, C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA) ‘both types P and C’, and IL-17], and nailfold capillaroscopic (NC), wherein the following capillaroscopic parameters were evaluated using an ophthalmoscope: distribution, presence of dilatation, presence of avascular areas, hemorrhages, and neoangiogenesis
The data collected from patients and controls were tabulated and statistically analyzed to study NC abnormalities and serum IL-17 pattern among RA patients with suspected vasculitis by positive NC changes and those with negative capillaroscopy

Summary

Introduction

Rheumatoid vasculitis (RV) is the most serious systemic disease manifestation of rheumatoid arthritis (RA), wherein it manifests almost exclusively in RA patients with rheumatoid autoantibodies and often occurs in the context of other extra-articular manifestations. Three histological patterns of vasculitis may be seen:. (1) A necrotizing leukocytoclastic vasculitis of dermal venules is seen in patients with palpable purpura, hemorrhagic bullae, maculopapular erythema, and erythema elevatum diutinum [5]. (3) Other histological patterns that can be seen include folliculocentric microabscess formation resembling dermatitis herpitiform and granulomatous vasculitis composed mainly of lymphocytes and histocytes [8]. (3) Collateral damage due to a local antigen-driven cellular immune response [13]. (2) An acute or healing arteritis of dermal subcutaneous vessels similar to that seen in polyarteritis nodosa is seen in patients with subcutaneous nodules, livedo reticularis, and ulcers [6,7]. (3) Other histological patterns that can be seen include folliculocentric microabscess formation resembling dermatitis herpitiform and granulomatous vasculitis composed mainly of lymphocytes and histocytes [8].

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