Nailfold Capillaroscopy Changes Research Articles

Evaluation of nail fold capillaroscopy changes in patients with diabetic retinopathy and healthy controls, and its correlation with disease duration, HbA1c levels and severity of diabetic retinopathy: An observational study

Background Diabetic retinopathy (DR) is an important microvascular complication of long-term type 2 diabetes mellitus (T2DM) leading to blindness if not properly diagnosed and managed. It can develop as early as 7 years before the diagnosis of diabetes. Nail fold capillaroscopy (NFC) is a non-invasive technique for observing capillary microvasculature and there are few studies which have explored the use of NFC in diabetes mellitus patients. Objective To study the nail fold capillaroscopic alterations in patients with T2DM having diabetic retinopathy and compare them to healthy controls. The secondary objective was to correlate the NFC findings with the duration of diabetes, haemoglobin A1c (HbA1c) levels and the severity of DR. Materials and methods This cross-sectional observational study enrolled 200 patients - 100 cases with T2DM having diabetic retinopathy (as per the American Diabetes Association criteria and Diabetic Retinopathy Disease Severity Scale) and 100 healthy age and sex-matched controls. All patients were subjected to NFC and ophthalmological assessment. Results NFC revealed that patients with DR showed significantly higher frequencies of tortuous, dilated, bushy, meandering, angulated capillaries, avascular areas and micro-haemorrhages as compared to healthy controls (p < 0.05). In proliferative DR (PDR), the frequency of tortuous, bushy capillaries, and avascular areas was statistically high and the capillary density was reduced as compared to non-proliferative DR. The DR patients with longer disease duration (>20) years had a significantly higher frequency of tortuous capillaries, avascular areas, meandering, angulated and dilated capillaries. The frequency of tortuosity, avascular areas, and bushy areas was significantly higher in patients with poor glycaemic control (HbA1c >11). Limitations A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM patients with DR. Discussion NFC may act as a surrogate marker of retinal involvement in patients with DM and should be performed at regular intervals. Conclusion NFC is a quick, simple, safe, and non-invasive method to assess the capillaroscopic alterations in diabetic patients which inturn can help in assessing the severity of DR.

A cross-sectional case-control study of nailfold capillaroscopy changes in patients with chronic kidney disease in tertiary care hospital in central India

Background Chronic Kidney Disease (CKD) poses a significant global health burden, necessitating a deeper understanding of its microvascular manifestations. Nailfold capillaroscopy has emerged as a valuable tool in elucidating microvascular changes in various systemic conditions, yet its application in CKD remains underexplored. This study aims to investigate the patterns of nailfold capillaroscopy changes in CKD patients across different stages and explore potential correlations with disease severity and etiology. Methods A cross-sectional case-control study will be conducted, enrolling 120 CKD patients (stage 1-5) and 60 controls without renal disease. Nailfold capillaroscopy will be performed using DINOLITE AM4113ZT, and microvascular changes will be analyzed through the MDAD approach. Demographic details, clinical histories, renal function tests, imaging findings, and additional relevant parameters will be collected. Statistical analysis, including chi-square tests, student t-tests, and correlation analyses, will be conducted using SPSS 27.0 and GraphPad Prism 7.0. Expected Outcome It is anticipated that nailfold capillaroscopy will reveal distinct microvascular changes in CKD patients compared to the control group. Correlation analyses with renal function parameters may unveil microvascular alterations and disease severity associations. The study’s findings hold the potential to enhance diagnostic and prognostic strategies in CKD, providing valuable insights into the vascular aspects of the disease and contributing to the broader understanding of microvascular changes in systemic conditions.

A Medical Record-based Pilot Study on the Diffusing Capacity of the Lungs for Carbon Monoxide versus Nailfold Capillaroscopy as an Early Marker for Lung Involvement in Connective Tissue Disease-related Interstitial Lung Diseases

Abstract Background: Connective tissue disease (CTD)-related interstitial lung diseases (ILDs) are one of the most common ILDs which affect relatively younger populations and can lead to extensive lung damage and fibrosis. Early detection and initiation of anti-inflammatory therapy can curtail the extent of lung damage. The diffusing capacity of the lungs for carbon monoxide (DLCO) is a well-established early marker of ILD. While most of the studies have shown specific nailfold capillaroscopy (NFC) findings in patients with CTD-ILD, none of them has evaluated the relation between diffusion impairment and nailfold capillary changes. The present study was carried out to evaluate the relationship between DLCO and NFC as markers for lung involvement in CTD-ILDs. Materials and Methods: This was a medical record-based observational study wherein the medical records of 100 diagnosed patients of CTD-ILD attending the pulmonology and rheumatology outpatient department were screened. Data concerning NFC, spirometry, and DLCO were collected and analyzed. Results: In our study of 100 patients, the minimum age was 29 years, and the maximum age was 78 years. A majority of patients in the study were found to be males (58%) and were suffering from CTD-ILD for a duration ranging from 2 to 5 years (58%). Eighty-nine percentage had a functional impairment on spirometry in the form of reduced forced vital capacity, and 61% had impaired DLCO. Nailfold capillary abnormalities were observed in all but one patient. The most common abnormal finding was a loss of capillary density (95% of patients) and a decrease in the intercapillary distance (94% of patients). A significant correlation was seen between diffusion impairment and abnormal nailfold capillary length. However, there was no significant correlation between DLCO and overall nailfold capillary abnormalities. Conclusion: The study concludes that NFC cannot be used as a tool to monitor diffusion impairment of the lungs in CTD-ILD. DLCO is a better assessment method compared to NFC changes as an indicator of lung involvement in CTD-ILD.

Nailfold capillaroscopy in Egyptian systemic lupus erythematosus (SLE) patients: correlation with demographic features and serum levels of IL 17A and IFNs I

BackgroundIn SLE patients, cytokines are linked to endothelial cell damage. Nailfold capillaroscopy (NFC) is a simple method for evaluating micro-vascular abnormalities in different connective tissue diseases (CTDs). The study aimed to detect the levels of interleukin 17A (IL 17A), type I interferons (IFNs I) in the serum, and NFC changes in Egyptian SLE patients compared to a control group and to correlate NFC findings with patients’ demographic features and serum levels of IL 17A and IFNs I.ResultsSerum levels of IL 17A, IFN α, and IFN β were significantly higher in SLE patients than in control group (P < 0.0001). About thirty nine patients (73.6%) of the 53 SLE patients showed abnormal NFC changes. Egyptian SLE patients had a high prevalence of the NFC non-specific pattern, with 32 (60.4%) patients showing non-specific changes and 7 (13.2%) patients showing scleroderma pattern, including 3 (5.6%) patients with active scleroderma pattern and 4 (7.55%) patients with late scleroderma pattern. Furthermore, Raynaud’s phenomenon (RP) was observed in 8 (15.1%) SLE patients, with 3 (5.6%) having normal NFC pattern and 5 (9.4%) having scleroderma pattern. All controls (n = 20) showed normal hairpin shape capillaries. Except for SLEDAI (P = 0.03) and the presence of RP (P < 0.0001), there were no significant differences in demographic and laboratory parameters between the three NFC patterns (normal, non-specific, and scleroderma); additionally, NFC score correlated significantly with SLEDAI (P = 0.021).ConclusionAs a result of the high disease activity, Egyptian SLE patients had elevated serum levels of IL 17A and IFNs I. The most common NFC pattern in Egyptian SLE patients was a non-specific pattern. NFC abnormalities in Egyptian SLE patients were correlated with disease activity but not with patients’ ages, disease duration, or serum levels of IL 17A and IFNs I. SLE patients with scleroderma NFC pattern and RP should be closely followed for the possibility of appearance of anti-U1 RNP antibodies and MCTDS.

Role of dermoscopy in detection of nailfold capillaroscopic changes in autoimmune connective tissue diseases

Role of dermoscopy in detection of nailfold capillaroscopic changes in autoimmune connective tissue diseases

Qualitative analysis of nailfold capillaries in diabetes and diabetic retinopathy using dermatoscope in patients with coloured skin.

Introduction Diabetes mellitus (DM) is associated with significant morbidity and mortality due to vascular complications. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Videocapillaroscope has been the predominant tool for nailfold capillary analysis. We aimed at using the commonly available handheld dermatoscope and observe changes in the nailfold capillaries as a part of evaluating diabetic microvascular involvement. Materials and methods A cross-sectional observational study involving 262 patients of diabetes mellitus and 150 controls was conducted for nailfold capillaroscopic changes using a hand-held dermatoscope over a period of 1 year. Results All the capillaroscopic variables like tortuosity, increased capillary density, neoangiogenesis, microhaemorrhages, avascular areas, crossing and meandering capillaries and receding capillaries were significantly more among diabetic than healthy controls. Patients with diabetic retinopathy had significant nailfold capillaroscopic features as compared to patients without DR (P value < 0.001). Neoangiogenesis, receding capillaries and avascular area were significantly higher in proliferative DR as against nonproliferative DR (P < 0.001). A positive association was found between the duration of DM and HbA1c values and NFC features. A decrease in the visualisation of NFC features was noted with increasing skin tone. The difference was significantly more between Fitzpatrick skin phototypes 4 and 5. Limitations The study was limited by its qualitative nature of accessing parameters as precise quantitative assessment of various findings cannot be done by a hand-held dermatoscope. Conclusion Nailfold capillaroscopy is a quick, cost-effective screening tool for identifying patients at high risk of DR in patients with skin of colour. NFC findings may mirror DR changes. The qualitative findings of NFC using a hand-held dermatoscope were comparable to other modes of nailfold capillaroscopy.

Study of Cutaneous Manifestations and Nail fold Capillaroscopic findings in Diabetes Mellitus and their correlation with Diabetic Retinopathy and Nephropathy- A Cross Sectional Observational Study

Objective: Long-term diabetes can lead to complications including diabetic macro- and microangiopathy. Capillaroscopy is a non-invasive method to evaluate capillary microvasculature which can be used to demonstrate changes in capillary microarchitecture noted in diabetic microangiopathy. The objective of this study was to study cutaneous manifestations of diabetes mellitus (DM), nailfold capillaroscopic changes due to diabetic microangiopathy, as well as to determine association between nailfold capillaroscopy (NFC) and cutaneous manifestations due to DM. Materials and Methods: Two hundred cases suffering from type 2 DM having cutaneous manifestations were enrolled in the study. Patients with autoimmune diseases, smokers and on long-term corticosteroids were excluded from the study. Detailed history was taken and the cutaneous manifestations related to type 2 DM were noted. NFC was done for all ten fingers of all patients. Additional investigations including HbA1c, urine microalbumin and fasting lipid profile were performed. Results: Out of 200 cases, 88 showed positive findings on NFC with the most common finding being altered tortuosity (seen in 85.2% cases). Chi-square test was done to demonstrate association between duration of DM and NFC which showed P-value of 0.027, which is statistically significant. Of the cases having nailfold capillaroscopic findings, 69/88 (78.4%) were found to have elevated HbA1C levels, 57/88 (57.9%) were found to have changes of diabetic retinopathy and 56/88 (63.6%) were found to have changes of diabetic nephropathy. Conclusion: NFC can provide key data for determination of vascular damage in diabetic patients and, thus, allows evaluation of progression of the disease making this technique a potential future utility in microvascular disease evaluation.

Study of the correlation between Nailfold capillaroscopic changes and the new potential biomarker of lupus nephritis activity

Background: In the past, researchers have looked for a variety of blood and urinary indicators for lupus nephritis (LN) in the hopes of identifying one that accurately reflects disease activity. Urinary alpha one antitrypsin is a new potential biomarker in detection of lupus nephritis which was discussed in this research. Capillaroscopic alterations have been shown to correlate with disease activity, including LN, suggesting that they may be helpful in assessing disease severity.Methods: Fifty individuals with SLE (as determined by the Systemic Lupus Erythematosus Disease Activity Index; SLEDAI) who also had at least six nailfolds suitable for microscopic evaluation participated in the research. Complete blood count (CBC), serum creatinine, and other diagnostic tests: blood urea and eGFR, Erythrocyte Sedimentation Rate (ESR), diagnostic marker for lupus (Anti –Nuclear Anti body (ANA), Anti-ds- DNA and Serum complement level (C3&C4), 24-hour urinary protein, complete urine analysis and urinary alpha one antichymotrypsin using ELISA technique in addition to nailfold capillaroscopic changes test (NFC).Results: Comparison between the normal and minor change group and between normal and major change group according to Urinary ALPH 1ACT, SLE activity, cutaneous manifestation showed high statistical significance p<0.001. There was Strong positive significant correlation between cases with SLE activity and had capillarscopic changes and high Urinary ALPH 1ACT. There was Strong positive significant correlation between urinary ALPH 1ACT, serum creatinine and 24HR urinary proteins.Conclusions: Urinary ALPH 1ACT is new potential biomarker of lupus nephritis, it was elevated in active SLE cases particularly active lupus nephritis and also with cases with capillaroscopic changes.

Роль капилляроскопии в оценке микроваскуляризации при ревматических заболеваниях

Nailfold capillaroscopy (NFC) is a non-invasive and safe tool for microvasculature assessment. Since its recent inclusion to classification criteria for systemic sclerosis (American College of Rheumatology (ACR) / European League Against Rheumatism (EULAR), 2013) and monitoring disease progression, the importance of NFC in rheumatology has increased. Given its growing use by a variety of physicians worldwide, both in daily practice to differentiate primary and secondary Raynaud’s syndrome, and in the context of research to predict the progression of the disease and evaluate the treatment effectiveness, the description of the acquisition and analysis of capillaroscopic images remains relevant. This report provides information on the interpretation of NFC changes, particularly in systemic sclerosis and other rheumatic diseases.

Diagnostic value of nailfold capillaroscopy changes in Henoch–Schönlein purpura children with gastrointestinal or renal involvement

Aim of the work: Capillaroscopy is known as a non-invasive, safe, and valuable diagnostic tool to assess the small vessels of the microcirculation in the nailfold. This study aimed to determine the diagnostic value of capillaroscopy in children with Henoch-Schönlein purpura (HSP) and major organ (gastrointestinal or renal) involvement which could increase the risk of complications. Patients and method: This study was conducted on 32 HSP children referred to the rheumatology ward of Children's Medical Center in Tehran, Iran, from 2019 to 2020, as well as 30 healthy controls. The vascular changes of the nailfold were assessed through capillaroscopy. Results: The mean age of the patients was 6.4 ± 2.2 years (3–11 years), and the female/male ratio was 1:1.7 (12 females and 20 males). The main finding of nail-fold capillaroscopy was abnormal morphology in 56.2 % of patients (vs. 6.7% control). A significant difference was seen between patients and control in terms of capillary morphology and architecture (p < 0.05). Abnormal capillary density and diameter tended to be more common in patients than in control (p > 0.05). Seven patients had gastrointestinal or renal involvement (21.9%). A high negative predictive value and low positive predictive value of density, architecture, and diameter of capillaries, were noted between patients with and without gastrointestinal and renal involvement. Conclusion: The role of microvascular involvement in children with HSP is emphasized. Changes in these vessels could be an image of this small vessel vasculitis to reflect major organ invovlement and thus avoid future complications of the disease.

Nailfold Capillaroscopic Changes as a Marker of Interstitial Lung Disease in Systemic Sclerosis: A Cross-Sectional Study in a Tertiary Care Hospital in Eastern India.

Background:Systemic sclerosis (SSc) is an autoimmune connective tissue disorder causing microvascular abnormality leading to Raynaud's phenomenon, skin tightening, and nailfold capillary changes. The patient may have systemic involvement, among them interstitial lung disease (ILD) and pulmonary arterial hypertension are mainly associated with disease-related mortality.Aims:To find out an association between nailfold capillaroscopic changes with ILD severity.Materials and Methods:An institution based cross-sectional study was performed among the patients of SSc above 18 years. Detailed history was taken. Clinical examinations, nailfold capillaroscopy (NFC) with a dermatoscope and high-resolution computed tomography (HRCT) scan of thorax were done. Data were analyzed in MedCalc statistical software version 20.Results:Out of total 43 patients, 74.4% (n = 32) were female. Mean age was 35.05 ± 7.24 years and mean duration 4.28 ± 2.81 years. Diffuse SSc was found in 88.37% (n = 38). On NFC, early, active, and late patterns were found in 30.2% (n = 13), 25.6% (n = 11), and 44.2% (n = 19) cases, respectively. On HRCT, early, active, and late ILD were present in 18.6% (n = 8), 37.2% (n = 16), and 30.2% (n = 13) cases, respectively. ILD changes were absent in 14% (n = 6) though NFC changes were present in them. Respiratory symptoms were absent in 20.93% (n = 9) patients though all had features of early NFC and among them 9.3% (n = 4) showed early ILD changes on HRCT. Significant associations were found between NFC changes and ILD severity (P = 0.0003), NFC changes and respiratory symptoms (P < 0.0001) and between ILD changes and respiratory symptoms (P < 0.0001).Discussion:NFC, an inexpensive procedure, can be performed in all patients of SSc to detect development of early ILD even before appearance of respiratory symptoms to prevent further progression.

Juvenile systemic sclerosis - observations of one clinical centre.

ObjectivesThe systemic form of scleroderma (SSc) in children is a very rare disease; therefore, it is recognized relatively late, which increases the risk of complications. The aim of the study was to assess the clinical symptoms of juvenile systemic sclerosis (JSSc) in our cohort patients.Material and methodsA group of (N = 22) scleroderma patients aged between 2 and 16 years were observed. Demographic data and all clinical results obtained during 16 years of observation in the clinic of rheumatic diseases of developmental age were collected and analysed.ResultsIn all observed children the major JSSc criterion was found, i.e. skin thickening proximal to the metacarpal phalangeal and/or metatarsophalangeal joints. Other symptoms are presented as follows: nailfold capillary abnormalities – 100%, Raynaud’s phenomenon – 90.9%, sclerodactyly – 27.3%, digital tip ulcers – 27.3%, dysphagia – 18.2%, gastroesophageal reflux – 27.3% (assessed in only 10 children), arrhythmias – 22.7%, heart failure – 9.1%, new-onset arterial hypertension – 9.1%, pulmonary fibrosis – 72.7%, pulmonary arterial hypertension – 9.1%, neuropathy – 13.6%, carpal tunnel syndrome – 4.5%, tendon friction rubs – 4.5%, arthritis – 22.7%, and myositis – 13.6%. There were no cases of renal crisis. Decreased diffusing capacity of oxygen was confirmed in 12 patients (58.3%). The presence of antinuclear antibodies was noticed in 86.7% of patients, and among SSc selective autoantibodies: anticentromere – 31.8%, anti-topoisomerase I – 18.2%, anti-PM-Scl 100 or 75 – 45.5%, anti-RP11, Th/To, PCNA in total in 27.3% were presented. In 4.5% of cases, apart from the presence of anti-PM-Scl autoantibodies, positive lupus band test, reduced concentration of complement, and antiphospholipid antibodies were also found. In 59% of studied children, the body mass index was below the 25th percentile.ConclusionsThe presented retrospective analysis shows that the occurrence of Raynaud’s phenomenon with changes in nailfold capillaroscopy is the best screening toll for the assessment of risk of JSSc. All patients of developmental age with Raynaud’s phenomenon, especially in the case of the appearance of antinuclear antibodies, should be monitored with capillaroscopy regardless of other laboratory or imaging tests.

PERNIOSIS: AN ENIGMATIC DERMATOLOGICAL ENTITY- STUDY OF ITS DEMOGRAPHIC PROFILE AND NAIL CAPILLAROSCOPIC CHANGES

BACKGROUND: Perniosis is a localised inammatory disorder affecting the unprotected skin regions of individuals exposed to damp, nonfreezing cold. The exact pathogenesis has not been elucidated, however, it is thought to be a microvascular disease. AIMS: To study the demographic prole of patients presenting with perniosis and examine the nailfold capillaroscopic (NFC) changes. MATERIAL AND METHODS: This was an observational, cross-sectional study conducted at a Tertiary care hospital of North India over a period of three months (November 2020- January 2021). Patients with idiopathic perniosis were included in the study. After detailed history and clinical examination, proximal nailfold (PNF) video capillaroscopy was performed in the affected digits. RESULTS: A total of 47 patients with idiopathic perniosis were recruited in the study consisting of 35 females and 12 males with female to male ratio of 2.9:1. A majority of individuals belonged to age group 21-35 years (38.29%). Lesions were localized to both hands and feet in 23 patients (48.9%), only hands in 19(40.4%) and only toes in rest 5 (10.6%) patients. Ten (21.2%) patients had family history of similar complaints and history of smoking was present in 2 (4%) patients. The mean BMI 2 recorded in 37 patients aged &gt;20 years was 20.72+4.32kg/m . Finger nail videocapillaroscopy performed in 42 patients showed dilated capillaries in 42.8%, tortuosity in 40.4% and microhaemorrhages in 28.5% patients. CONCLUSION: In the present study, presence of nailfold capillaroscopic changes suggested that an organic damage to the microcirculation is present in perniosis. Low BMI is an important association for development of perniosis. LIMITATIONS: Long term follow up is required for patients with chilblains to assess permanency of nailfold capillaroscopic changes.

Relationship between type of skin lesions and nailfold capillaroscopy pattern in mixed connective tissue disease

IntroductionMixed connective tissue disease (MCTD) is a rare disease with clinical picture consisted of multiple organ manifestations, including skin changes resembling systemic lupus erythematosus (SLE), systemic sclerosis (SSc), or dermatomyositis (DM). On the background of these manifestations are microvascular changes — alteration of endothelial function and impairment of endothelial progenitor cell. Nailfold capillaroscopy (NFC) is a simple, non-invasive technique for investigating microvascular involvement in rheumatic diseases.ObjectivesTo describe the relationship between type of skin lesions and NFC pattern in MCTD patients.MethodsWe analyzed the clinical picture and NFC patterns in 79 patients with MCTD. The NFC changes were classified into Normal, “Early,” “Active,” and “Late” scleroderma-like patterns (SD-like pattern) based on Cutolo classification.In all patients, subjective and physical examinations were carried out, specifically the occurrence of skin lesions in the course of MCTD was assessed (systemic sclerosis-like (Ssc-like), systemic lupus erythematosus-like (SLE-like), dermatomysitis-like (DM-like)).ResultsSkin changes were present in 64 (81%) patients, involving 43 (54%) SLE-like, 48 (61%) SSc-like, and 4 (5.1%) DM-like. NFC changes were observed in a total of 55 (69.6 %) patients with predominance of the “Early” pattern — 41 (51.9 %) patients. According to skin change phenotypes, NFC changes were observed in 31 (72%) patients with SLE-like and in 32 (66.7%) patients with SSc-like skin phenotypes. The “early” pattern predominated in both group.ConclusionsWe did not find any correlation between NFC pattern and the type skin changes.Key Points• The study did not show a correlation between the presence and absence of skin lesions and NFC pattern.• Scleroderma-like patterns were found in over 60% of patients with mixed connective tissue disease.• The “early” pattern is dominant regardless of the occurrence or absence of skin lesions in patients with MCTD.• Skin lesions, regardless of their type (SLE or SSc), do not correlate with type of lesion found in the NFC examination.

Vascular endothelial growth factor profile and Vitamin D level in Systemic Sclerosis Egyptian patients

Vascular endothelial growth factor (VEGF) was described as a potentially important driver of systemic sclerosis (SSc) pathogenesis. Additionally, recent literature elucidated that vitamin D serum level was found to be significantly lower in SSc patients in comparison to healthy individuals. The aim of the current study was to evaluate serum level of VEGF and its correlation with clinical features and vitamin D level in systemic sclerosis (SSc) Egyptian patients. This current case control study included 30 female SSc patients and 20 healthy controls. VEGF level was measured by ELISA. Serum level of 25-OH vitamin D was measured by electrochemiluminescence. Nailfold video capillaroscopy and modified Rodnan skin score (mRSS) were assessed. Thirty SSc female patients were included in the study, 13 patients had diffuse cutaneous SSc. The mean age of the patients' group was 49.3±4.3years, and the mean serum VEGF level was 3445.9±1183 ng/dl. The mean serum level of vitamin D was 15.57±9.9ng/ml in SSc patients and 30.6±2.26 in the controls. There was a significant association between high level of VEGF and hypovitaminosis D. Serum level of VEGF positively correlated with nailfold capillaroscopy changes and mRSS. In conclusion, high level of VEGF is associated with hypovitaminosis D, suggesting a role of vitamin D in SSc pathogenesis. VEGF levels correlate positively with nailfold capillaroscopy changes and extent of skin involvement.

English

BACKGROUND The nailfold capillaroscopy (NFC) has been used to analyse capillary microarchitecture in diseases like Raynaud’s disease, scleroderma, and other collagen disorders earlier but recently researchers have documented capillaroscopic findings in diabetic patients which correspond to their ophthalmoscopic findings. Every diabetic patient after ten years of the disease is at risk of diabetic retinopathy and should thereby be referred to an ophthalmologist for screening. But for various factors the referral to ophthalmologists is poor and the patients usually present to the ophthalmologist when their vision is threatened. Our study intends to correlate the nailfold capillaroscopic microvascular changes with duration of diabetes, severity of diabetic retinopathy (DR), compare the changes of patients with DR and without DR and determine its role as a screening tool. METHODS This was a hospital based cross-sectional study for over 18 months in patients (15 - 75 yrs. of age) with diabetes mellitus. Patients with other vascular disorders were excluded. The study subjects were evaluated for diabetic retinopathy by indirect ophthalmoscopy, fundus pictures and optical coherence tomography. The nailfold capillaroscopy findings were recorded and co-related with fundus findings. Statistical analysis was done by using the STATA software version 15.1. RESULTS Two hundred and fifty patients were recruited with 125 patients in each group, patients with and without DR respectively. Poor glycaemic control was seen most commonly in patients with proliferative diabetic retinopathy. The reduced capillary density, tortuosity, microhaemorrhages, neoangiogenesis and avascular areas were seen more frequently in proliferative diabetic retinopathy than nonproliferative diabetic retinopathy and patients without DR. (P value 0.00). CONCLUSIONS Changes in nailfold capillaroscopy in diabetics have significant association with severity of DR, duration of diabetes, and glycaemic control. It could be used as screening and early diagnostic tool for non-ophthalmology medical fraternities to refer to ophthalmologist for follow-up and treatment of diabetic retinopathy. KEYWORDS Diabetes Mellitus, Diabetic Retinopathy, Nailfold Capillaroscopy, Microangiopathy

Nailfold Capillaroscopic Changes in Dermatomyositis and Polymyositis Egyptian Patients: Relation to Disease Activity

Background: Nailfold capillaroscopy (NFC) has been described to be a valuable instrument used in diagnosis of systemic sclerosis (SSc) and juvenile dermatomyositis (JDM) patients. Though, NFC has been infrequently assessed in adult dermatomyositis (DM) patients. Objectives: Our aim was to visualize nailfold capillary changes in dermatomyositis (DM) and polymyositis (PM) Egyptian patients and to identify a specific diagnostic capillary pattern and to assess its relevance to disease activity, clinical and laboratory findings. Patients and Methods: This study included 20 patients (12 DM, 5 PM, and 3 overlap syndrome). Routine laboratory assessment was done, disease and skin activity scores were evaluated. Assessment of the nailfold capillary circulation using the videocapillaroscope was done and capillary density score was assessed. Results: The mean age was 39±12 years and their mean disease duration was 24±19 months. The mean muscle disease activity score was 3.8±3.3, and global disease activity score (DAS) 3.92±3.09. The mean skin activity score was 2±3. The global DAS was significantly higher in patients with branched capillaries (p=0.041). Skin activity score was significantly higher in patients with capillary hemorrhage (p=0.024). More severe capillaroscopic findings were prominent in DM patients rather than PM or overlap patients. Conclusion: Capillary branching is more common in patients with higher global DAS and capillary hemorrhage is more frequent in patients with higher skin activity score. Capillaroscopic changes are evident in DM patients rather than PM or overlap patients.

Nailfold Capillaroscopic Changes in Dermatomyositis and Polymyositis Egyptian Patients: Relation to Disease Activity

Nailfold capillaroscopy (NFC) has been described to be a valuable instrument used in diagnosis of systemic sclerosis (SSc) and juvenile dermatomyositis (JDM) patients. Though, NFC has been infrequently assessed in adult dermatomyositis (DM) patients.

Nail Fold Capillaroscopy Abnormality in Behcet's Disease and Relation to Disease Activity among Egyptian Patients

Background: Behcet’s disease is a systemic autoimmune disease. Treatment mainly is immunosuppression. It has no sure diagnostic tests and relies mainly on clinical diagnosis. There are few scores to assess Behcet's disease activity (Behcet's Disease Current Activity Form) BDCAF score. Nailfold Capillaroscopy is a technique to visualize capillaries in nailfold area. It can correlate many diseases with the abnormalities in shape of blood capillaries. Objectives: The aim of the work was to find out Nail Fold Capillaroscopy abnormality in Behcet's Disease and its relation to the disease activity. Patients and Methods: A cross sectional-case control study which was done on 50 Behcet’s patients and 30 healthy controls. We assessed nailfold capillaroscopic changes in Behcet’s patients in comparison to controls and the correlation of BDCAF score with nailfold capillary abnormalities. Results: we found that 70% of Behcet's Disease patients had nailfold capillaroscopy abnormalities , a highly statistically significant changes in the capillaries in the form of capillary dilatation (24%), hemorrhage (54%), tortuosity (64%) in comparison to the control group (P<0.001). However, pattern was not specific as BDCAF Score wasn’t related to the capillary changes. Conclusion: Nailfold capillaroscopy showed nonspecific pattern in 70% Behcet's disease patients. Tortuosity, hemorrhages, dilation were not related to disease activity. Capillaroscopy is a good primary test for Bechet’s disease and can reflect the presence and extent of microvascular involvement and thereby might have diagnostic and prognostic value.

Vascular endothelial growth factor (VEGF), tissue inhibitors of metalloproteinase-1 (TIMP-1) and nail fold capillaroscopy changes in children and adolescents with Gaucher disease; relation to residual disease severity

BackgroundGaucher disease (GD) is caused by functional defects of the acid β-glucocerebrosidase enzyme, with accumulation of glucosylceramide in the macrophage lineage lysosomes causing multisystem abnormalities. However, some GD manifestations can’t be explained by Gaucher-cells infiltration. Recent studies emphasized the role of inflammation in GD. AimTo compare the level of TIMP1 (Tissue-inhibitory metalloproteinase-1) and VEGF (Vascular-endothelial growth factor) and nail-fold capillaroscopy (NFC) changes in children and adolescents (CA) with GD and controls and correlate them to disease-severity, genotype, visceral and neurological manifestations. MethodologyFifty-three CA with GD were compared to 52 age and sex matched healthy controls stressing on ERT (enzyme replacement therapy) dose and duration, pulmonary, hematological and neurological manifestations with assessment of severity-scoring index (SSI). Full neurological, abdominal and chest examinations were done. Sonographic liver and spleen volumes and NFC were assessed. GD genotype was done. Serum TIMP-1 and VEGF were measured. ResultsCA with GD had significantly higher TIMP-1 (P < 0.001) and VEGF (P < 0.001) than controls. Type 3CA with GD had significantly higher TIMP-1 (P = 0.004) and VEGF (P = 0.035) than type 1. There was a significant positive correlation between TIMP-1 and each of VEGF (P < 0.001), SSI (P < 0.001) and NFC (P < 0.001). A significant positive relation was found between TIMP-1 and convulsions (P = 0.002), dysphagia (P = 0.008), opthalmoplegia (P = 0.038) and developmental delay (P < 0.001). Multi-variate logistic regression analysis for predictors of children and adolescents with GD revealed that its most correlated to TIMP-1 (P = 0.008) and NFC changes (P = 0.025). ConclusionMacrophage proliferation in GD modulates local inflammation, micro-angiopathy and neo-angiogenesis. NFC can be used as a noninvasive indicator of microangiopathy in GD.