Nailfold Videocapillaroscopy Research Articles

Nailfold video capillaroscopy in Turner syndrome: a descriptive study

BACKGROUND: An increased prevalence of impaired glucose homeostasis is reported in Turner syndrome. Endothelial changes are described in patients with insulin resistance, which may be present in patients with Turner syndrome. Video capillaroscopy is a noninvasive examination that allows assessment of vascular patency. OBJECTIVE: To describe the nailfold morphology of capillaries in Turner syndrome using video capillaroscopy. METHODS: Subjects were studied in a temperature-controlled room, 20 days after no nailfold manipulations. The capillaries were visualized by microscope connected to a television and computer and were studied and classified according to these patterns: loop distribution, papilla, avascular fields, edema, form, capillary limbs, flow and hemorrhagic extravasation. RESULTS: Fifty patients aged between 6-37 years with Turner syndrome were studied. Eighteen (36%) patients had normal capillaroscopy with hairpin pattern in loop distribution and no avascular fields. The papilla was ratified in 13 (26%) and enlarged in four (8%). Edema occurred in 22 (44%) cases. There were three (6%) macrocapillaries and three (6%) were branched. Tortuosity was present in five (10%) patients. Hemorrhagic extravasation occurred in one (2%) case. Flow was fast in seven (14%), granulous in five (10%) and slow in six (12%). CONCLUSION: There was a high prevalence of nailfold capillaroscopy changes in Turner syndrome and the most prevalent alterations found were edema and ratified papilla.

The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases

Raynaud's phenomenon (RP) is one of the earliest clinical hallmarks of microvascular involvement in several connective autoimmune rheumatic diseases. The direct observation of the microvasculature with nailfold videocapillaroscopy (NVC) is useful for an early diagnosis of connective autoimmune diseases (secondary RP) and differentiation from primary (unsymptomatic) RP. Generally, to detect early pathologic capillaroscopic changes, the following parameters are considered: presence of enlarged and giant capillaries, haemorrhages, disorganization of the vascular array, ramified/bushy capillaries and loss of capillaries. Careful capillaroscopic analysis of subjects affected by primary RP can detect the earliest signs of the transition to secondary RP and thus screening procedures for further differential diagnosis within connective autoimmune diseases can be undertaken. In systemic sclerosis, the recognition of clear and different NVC morphological patterns ("early", "active", "late") should suggest including this analysis in the classification criteria of the disease.

Scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients

Background:Longitudinal study to define a scoring system to quantify the specific capillary abnormalities, as observed by capillary microscopy in systemic sclerosis (SSc).Methods:Ninety patients with SSc were evaluated by nailfold videocapillaroscopy...

Anticardiolipin and anti-β2glycoprotein I antibodies and lupus-like anticoagulant: prevalence and significance in systemic sclerosis

It has been suggested that both anticardiolipin (aCL) and anti-beta(2) glycoprotein I (abeta(2)GPI) antibodies may play a critical role in the pathogenesis of systemic sclerosis (SSc)-related vascular impairment. To evaluate the prevalence of aCL and abeta(2)GPI antibodies and lupus-like anticoagulant (LAC) in patients with SSc and healthy controls. We also investigated a possible relationship between clinical and biological variables of patients with SSc and the presence of aCL/abeta(2)GPI antibodies and/or LAC. Measurements of aCL and abeta(2)GPI antibodies, and LAC were performed in 69 consecutive patients with SSc and 69 age- and sex-matched controls. Clinical and biological findings were compared between patients with and without antiphospholipid antibodies. aCL and abeta(2)GPI antibodies and/or LAC were detected in 13 (19%) of 69 consecutive patients with SSc; in the healthy control group, aCL antibody was found in only one (2%) subject (P = 0.0007). None of the healthy controls had abeta(2)GPI antibody and/or LAC. Moreover, pitting scars, pulmonary arterial hypertension, macrovascular involvement as well as severity of capillary impairment (using nailfold videocapillaroscopy) were more frequent in SSc patients with aCL/abeta(2)GPI antibodies and/or LAC compared with those without. Our findings suggest that antiphospholipid antibodies may have a role in the genesis of vascular involvement related to SSc. Finally, the assessment of antiphospholipid antibodies (aCL and abeta(2)GPI antibodies, as well as LAC) may contribute to a better recognition of clinical features in patients with SSc; in essence, the patients with aCL/abeta(2)GPI antibodies and/or LAC may require close monitoring of vascular changes, including in particular pulmonary arterial hypertension and digital infarcts.

Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity

To evaluate in a large group of scleroderma patients, the association of nailfold videocapillaroscopic patterns with both demographic and clinical features. One hundred and three Italian patients (91 women and 12 men, mean age 54.3 years, median disease duration 7 yrs, 68 with limited and 35 with diffuse subset of disease), consecutively enrolled for the study, underwent nailfold videocapillaroscopy; the microvascular alterations were classified into three different patterns, early, active and late. The nailfold videocapillaroscopic patterns were correlated with such numerous clinical features as sex, age, disease duration, disease subset, disease activity, haematochemical data, involvement of skin, heart, lung and peripheral vessels. Nailfold videocapillaroscopic patterns were significantly associated with disease subsets (P = 0.018). Severity of skin, lung, heart and peripheral vascular involvement progressively increased across nailfold videocapillaroscopic patterns, from early to late pattern (P < 0.001 for cutaneous and peripheral vascular involvement; P = 0.003 and 0.002 for lung and heart involvement, respectively) as well as homocysteine plasma levels (P = 0.02). Patients with late pattern showed an increased risk to have an active disease [OR (odds ratio) 3.50; 95% CI (confidence interval) 1.31-9.39], to present digital ulcers (OR 5.74; 95% CI 2.08-15.89) and moderate to severe skin (OR 5.28; 95% CI 1.93-14.19), heart (OR 5.75; 95% CI 2.04-16.21) and lung involvement (OR 4.41; 95% CI 1.63-11.92). Our study showed that scleroderma microangiopathy correlates with disease subset and severity of peripheral vascular, skin, heart and lung involvement; patients with late pattern showed an increased risk to have an active disease and to show a moderate/severe skin or visceral involvement compared to patients with early and active patterns. Therefore nailfold videocapillaroscopy, a simple, non-invasive and non-expensive investigation, is useful in staging scleroderma patients and also provides prognostic information.

Identification of transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon by nailfold videocapillaroscopy: Comment on the article by Hirschl et al

Identification of transition from primary Raynaud's phenomenon to secondary Raynaud's phenomenon by nailfold videocapillaroscopy: Comment on the article by Hirschl et al

Dysfonctionnement vasculaire dans les désordres métaboliques : evaluation de quelques essais thérapeutiques

Cardiovascular diseases continue to be the main cause of death in most industrialized countries. Endothelial dysfunction, a systemic process, is the earliest known marker of atherosclerosis and has become a major focus in acute ischemic disorders. We are investigating the hypothesis that, in these diseases, microvascular and endothelial dysfunctions occur simultaneously and precede the onset of macrovascular disease. We studied, to our knowledge for the first time in the same subjects, microvascular and endothelial functions in 11 patients with type 2 diabetes. 36 metabolic syndrome patients (NCEP-ATPIII criteria) and 25 young obese women matched with healthy controls. Micro vascular morphology and hemodynamics were evaluated non-invasively by means of nailfold videocapillaroscopy. Red blood cell velocity (RBCV, mm/s) was measured at rest and after release from 60 s of arterial occlusion (RBCVmax, mm/s) at the finger base, along with the time to reach RBCVmax (TRBCVmax, s), by video analysis with Cap Image software. Venous occlusion plethysmography was performed after intra-arterial infusions of acetylcholine and sodium nitroprusside to assess endo thelial-dependent and -independent vasodilation, respectively. We found similar results in the three groups of subjects, namely a significant decrease in RBCVmax, an increase in TRBCVmax, and a decrease in endothelial-dependent vasodilation. These findings clearly demonstrate that the two dysfunctions occur simultaneously in these groups of patients. Several mechanisms which could impair micro vascular and endothelial functions are associated with insulin resistance, and drugs that act on insulin resistance might thus be beneficial. Metformin, given to 16 first-degree relatives of patients with type 2 diabetes mellitus, who had the metabolic syndrome and normal glucose tolerance (ADA criteria), improved endothelial-dependent vasodilation and microcirculatory function. Rosiglitazone, given to 18 patients with the metabolic syndrome, enhanced vascular responses by improving endothelial function and increasing adiponectin levels. Increased triglyceride storage is often associated with insulin resistance, contributing to free fatty acid (FFA) overexposure. The two drugs tested here stimulate AMP-activated protein kinase, which promotes FFA oxidation and thus reduces oxidative stress, and might therefore attenuate endothelial lipotoxicity. The results strongly suggest that targeting micro vascular and endothelial dysfunctions in patients with metabolic disorders might help to prevent cardiovascular events, and warrant long-term clinical trials.

Metformin improves skin capillary reactivity in normoglycaemic subjects with the metabolic syndrome

Insulin resistance and a parental history of diabetes mellitus are independently associated with endothelial dysfunction. Oxidative stress has a pivotal role in the pathophysiology of vascular injury. Metformin, in addition to its glucose-lowering properties, has vasculoprotective effects. We investigated whether metformin has beneficial effects on the nutritive skin capillary circulation and deceases oxidative stress in a group at high risk for Type 2 diabetes mellitus (T2DM) and cardiovascular disease. Thirty normoglycaemic subjects with the metabolic syndrome (MS),who had first-degree relatives with T2DM, participated. The mean age was 39.1 +/- 8.4 years and body mass index (BMI) 35.7 +/- 4.8 kg/m2 (mean +/- SD). were randomized 1 : 1 to receive placebo (n=14) or metformin (n=16; 1700 mg/day) in a double-blind study. At baseline and post treatment, blood and urine samples were collected for biochemical and 8-epi-prostaglandin F2alpha (8-epi-PGF2alpha) analysis, respectively. Microcirculation was assessed by nailfold videocapillaroscopy, analysing afferent (AF), efferent (EF) and apical (AP) diameters of capillary loops, functional capillary density (FCD), red blood cell velocity at rest (RBCV), after 1 min arterial occlusion (RBCVmax) and time (TRBCVmax)taken to reach it. Groups did not differ significantly in anthropometric, clinical, laboratory or microvascular measurements at baseline. In the metformin group, weight,BMI, systolic blood pressure and fasting plasma glucose fell, and lipid profile and microcirculatory parameters FCD, AF, EF, AP, RBCVmaxand TRBCVmax improved (all P<0.01). No relationship between clinico-laboratory parameters and microvascular reactivity was observed, except for changes in total and low density lipoprotein-cholesterol and RBCVmax* 8-epi-PGF2alpha did not change significantly in either group. Metformin improved skin capillary reactivity in normoglycaemic MS subjects independently of significant changes in 8-epi-PGF2alpha levels.

Correlation between homocysteine plasma levels and nailfold videocapillaroscopic patterns in systemic sclerosis

The aim of the study is to investigate the relationship between microangiopathy as assessed by nailfold videocapillaroscopy (NVC) and plasma level of homocysteine (Hcy) in systemic sclerosis (SSc). As known, Hcy is a nonessential amino acid that interferes with normal properties of a vascular tree. Sixty patients affected by SSc (4 men and 56 women, mean age 54.6) underwent the determination of plasma Hcy level; at the same time, NVC was performed. Hcy level was also determined in 30 sex- and age-matched controls. In patients affected by SSc the plasma Hcy level was significantly higher than in healthy controls (11.8 and 6.5 micromol/l, respectively; p < 0.001). A significant correlation was found between plasma Hcy concentration and the pattern of NVC with a progressive increase from early to active and above all to late pattern (10.7, 11.8, and 17.4 micromol/l, respectively; p < 0.001). Subjects with high Hcy level (i.e., >75th percentile of Hcy level in controls and in patients considered altogether) were mostly represented in the scleroderma patients with late nailfold videocapillaroscopic pattern; the crude odds ratio was 9.0 (significant; 95% CI from 2.1 to 38.8). In conclusion, Hcy plasma level is related to microvascular involvement in patients affected by SSc; the concentration increases with the progression of the nailfold videocapillaroscopic pattern. Hyperhomocysteinemia may represent an aggravating factor among the complex mechanisms involved in scleroderma damage contributing to the injury of endothelium.

Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement?

Raynaud's phenomenon (RP) represents the most frequent clinical aspect of cardio/microvascular involvement and is a key feature of several autoimmune rheumatic diseases. Moreover, RP is associated in a statistically significant manner with many coronary diseases. In normal conditions or in primary RP (excluding during the cold-exposure test), the normal nailfold capillaroscopic pattern shows a regular disposition of the capillary loops along with the nailbed. On the contrary, in subjects suffering from secondary RP, one or more alterations of the capillaroscopic findings should alert the physician of the possibility of a connective tissue disease not yet detected. Nailfold capillaroscopy (NV) represents the best method to analyse microvascular abnormalities in autoimmune rheumatic diseases. Architectural disorganization, giant capillaries, haemorrhages, loss of capillaries, angiogenesis and avascular areas characterize >95% of patients with overt scleroderma (SSc). The term 'SSc pattern' includes, all together, these sequential capillaroscopic changes typical to the microvascular involvement in SSc. The capillaroscopic aspects observed in dermatomyositis and in the undifferentiated connective tissue disease are generally reported as 'SSc-like pattern'. Effectively, and early in the disease, the peripheral microangiopathy may be well recognized and studied by nailfold capillaroscopy, or better with nailfold video capillaroscopy (NVC). The early differential diagnosis between primary and secondary RP is the best advantage NVC may offer. In addition, interesting capillaroscopic changes have been observed in systemic lupus erythematosus, anti-phospholipid syndrome and Sjogren's syndrome. Further epidemiological and clinical studies are needed to better standardize the NCV patterns. In future, the evaluation of nailfold capillaroscopy in autoimmune rheumatic diseases might represent a tool for the prediction of microvascular heart involvement by considering the systemic microvascular derangement at the capillary nailfold.

Nailfold Videocapillaroscopy in Primary Sjögren’s Syndrome

Nailfold videocapillaroscopy was performed in 2 groups of subjects: 14 healthy volunteers (C) and 15 patients with primary Sjögren's syndrome (PSS). This was a controlled clinical trial, matched by age and sex. The aims of this study were to evaluate (1) functional capillary density (number of capillaries with flowing red blood cells per mm(2), FCD); (2) capillary red blood cell velocity at rest (RBV), maximum capillary red blood cell velocity (RBV(max)) after 1 minute ischemia, and the time to reach it (TRBV(max)), taking into account the presence or absence of Raynaud's phenomenon (RP) in the analysis; (3) nailfold capillary morphology; and (4) afferent (AFD), apical (APD), and efferent (EFD) capillary diameters. The mean values obtained for controls versus patients, respectively, were (mean +/- SD): FCD (per mm(2)) 8.0 +/-1.6 and 10.1 +/-3.6; RBV (mm/s) 0.9 +/-0.4 and 0.7 +/-0.2; RBV(max) (mm/s) 1.7 +/-0.9 and 1.3 +/-0.3; TRBV(max) (s) 4.5 +/-0.8 and 5.8 +/-1.6 (p=0.02); and TRBV(max) (s) in patients with RP=6.7 +/-1.6 and without RP=5.6 +/-1.6 (p=0.52). The correlation between RBV and RBV(max) for each group, using the Pearson's coefficient, was significant only for the control group (p=0.007), estimated correlation coefficient = 0.68. Controls and patients showed, in the majority of fields examined, normal morphologic patterns of capillaries. The capillary diameters were AFD (mum) 10.8 +/-1.5 and 11.3 +/-1.8; APD (mum) 16.3 +/-2.4 and 16.8 +/-2.9; and EFD (mum) 12.3 +/-1.4 and 13.7 +/-1.9. These results indicate that these patients have longer time to reach RBV(max), suggesting an impairment of the reactive hyperemia response, which could correlate with clinical features of the disease, ie, abnormal macrovascular and microvascular reactivity.

Nailfold videocapillaroscopy for the early diagnosis of systemic sclerosis in Raynaud's phenomenon

Raynaud's phenomenon is characterized by an exaggerated vasospastic response induced by cold or emotional stress. It can be primary (idiopathic) or secondary to a number of different conditions, including predominantly systemic sclerosis (SSc). Currently, the best technique available to study microvascular involvement in Raynaud's phenomenon is nailfold videocapillaroscopy (NVC). The actual and exclusive advantage of early NVC analysis is to distinguish between primary and secondary Raynaud's phenomenon and to allow the early detection of SSc. Recently, microvascular alterations, as detected by NVC in patients with SSc, have been reclassified into three different patterns: early, active and late. These large investigations have confirmed previous observations, indicating enlarged and giant capillaries, together with microhemorrhages and edema, as the earliest NVC finding in SSc (early pattern). The NVC patterns have been correlated with different clinical aspects and manifestations of SSc, as well as trea...

Levels of F2-isoprostanes in systemic sclerosis: correlation with clinical features

Oxidative stress may be one of the important complex pathogenetic mechanisms that lead to damage in scleroderma; free radicals may provoke endothelial injury, fibroblast proliferation and fragmentation of autoantigens favouring induction of autoantibodies. The present study investigates the oxidant status in scleroderma patients by measuring the urinary concentration of 8-isoprostaglandin-F2alpha, an F2-isoprostane, and a product of free radical-mediated peroxidation of arachidonic acid. Forty-three scleroderma patients (42 women and 1 man, mean age 54.1 yr, mean disease duration 9.0 yr) underwent clinical evaluation and instrumental investigations in order to assess skin, vascular, lung and heart involvement. Von Willebrand factor was evaluated as marker of vascular dysfunction in 36 out of the 43 cases. The urinary level of 8-isoprostaglandin-F2alpha was measured in all scleroderma patients and in the 43 age- and sex-matched healthy controls. Urinary levels of 8-isoprostaglandin-F2alpha were higher in scleroderma patients than in the healthy control group (341.7 vs 147.6 pg/mg creatinine; P < 0.001). Values of 8-isoprostaglandin-F2alpha were strongly correlated with the nailfold videocapillaroscopy pattern and lung involvement (P = 0.002 and 0.003, respectively), showing increasing levels with the progression of pulmonary severity. Correlation between 8-isoprostaglandin-F2alpha level and von Willebrand factor narrowly failed to reach statistical significance (P = 0.05). There was no correlation between 8-isoprostaglandin-F2alpha concentration and disease activity, vascular, skin and heart involvement, disease pattern or autoantibody profile. Our study further supports the role of oxidant stress in the pathogenesis of scleroderma, showing a strong correlation between a marker of free radical damage with both the severity of lung involvement and the videocapillaroscopic patterns.

Nailfold videocapillaroscopy in patients with systemic lupus erythematosus

Nailfold videocapillaroscopy was performed in 21 controls (C) and 21 patients (P) with systemic lupus erythematosus (SLE) classified according to the American College of Rheumatology, with, at least, 1 year of diagnosed disease and having low activity (MEX-SLEDAI) and sequel (SLICC) indexes at the time of the examination, paired by sex and age. Red blood cell velocity (RBCV, mm/s) at rest and after the release of 60s arterial occlusion (RBCVmax, mm/s), time to reach it (TRBCVmax, s), functional capillary density (FCD, number of capillaries /mm2), afferent, apical and efferent capillary diameters (microm) (DAF, DAP and DEF, respectively) were obtained from videotapes analyzed by the CapImage software. The results did not show any significant difference between the groups that were analyzed, suggesting that morphological (capillary diameters) and functional (RBCV, RBCVmax, TRBCVmax and FCD) parameters are not affected by SLE when low activity and sequel indexes of the disease are present.

Nailfold video-capillaroscopy in systemic sclerosis

The Raynaud's phenomenon (RP) is the most common and significant clinical condition supporting microvascular analysis as soon as possible. Microvascular involvement is a key feature of RP, and several rheumatic diseases are characterized by the presence of the RP. Nailfold capillary microscopy shows an impressive cost/effectiveness ratio: it is simple, noninvasive and inexpensive.Well-recognized videocapillaroscopic patterns (NVC) have been described mainly in scleroderma (SSc) patients complaining of a secondary RP. The peripheral microvascular damage in SSc is characterized by increasing structural alterations of the capillaries (giant capillaries and microhemorrhages) with progressive decrease of their density. The detection of the scleroderma NCV allows early differentiation between primary RP (functional, not disease associated), and secondary RP (disease associated). Other major NVC patterns have been described in the field of rheumatic diseases. Interestingly, correlations are evident between the NCV and the clinical symptoms, severity of the disease and the laboratory findings. Further clinical and epidemiological studies, as well as a standardized and computerized quantitation of the observed damages are required.

Laser Doppler imaging: a developing technique for application in the rheumatic diseases.

Microcirculatory abnormalities contribute to the pathogenesis and pathophysiology of many of the rheumatic diseases. This is best recognized in systemic sclerosis (SSc), in which structural microvessel disease can be well demonstrated using the technique of capillary microscopy [1], and more recently by video and digital capillaroscopy [2, 3]. However, in many other conditions the microvasculature is more subtly involved. By the ‘microvasculature’ we mean the arterioles, the capillaries and the venules. Any inflammatory state is associated with profound microvascular perturbation. For example, in rheumatoid arthritis the synovial microvasculature undergoes major change with formation of new blood vessels (angiogenesis) in the hypertrophied synovium and with lymphocyte trafficking through high endothelial venules. These high endothelial venules are lined by specialized endothelial cells whose formation has been induced during the inflammatory process. [4]. In the study of disease, we must be concerned not only with understanding basic pathophysiology but also with the measurement of disease progression. If we cannot measure the disease, then we cannot assess its progression or responsiveness to treatment. In addition, the ability to measure disease processes can give us indirect insights into pathophysiology by allowing us to assess response to therapeutic interventions which are known to have specific mechanisms of action. Can we measure microvascular disease/involvement by disease, and apply this to the study of rheumatological disorders? As already mentioned, we can examine nailfold capillary structure in certain connective tissue diseases, such as SSc and dermatomyositis, using nailfold microscopy and video capillaroscopy, and one aspect of capillary function (permeability) can be examined by fluoroscopy [5, 6], which is, however, invasive in that it requires an intravenous dye injection. In this review we shall discuss the relatively new technique of laser Doppler imaging (otherwise termed ‘scanning laser Doppler’), which gives a direct measure of microcirculatory flow. We believe laser Doppler imaging affords significant potential in the study of microcirculatory involvement of the rheumatic diseases and it is non-invasive. Background to laser Doppler blood flow monitoring The observed wavelength of electromagnetic radiation is affected by relative motion between the source and observer. This phenomenon (also applicable to sound waves, as in the technique of Doppler ultrasound) is known as the Doppler effect. When low-level laser light, of a few milliwatts, is directed onto the skin’s surface a fraction of the light penetrates the skin and interacts with both static tissue and moving cells (primarily red blood cells). The penetration depth of light is dependent upon the tissue morphology, absorption and the wavelength used [7, 8]. The light that is reflected or randomly scattered from the static tissue remains unchanged in wavelength. In contrast the light that is scattered from the moving blood cells undergoes a small change in wavelength, proportional to the speed of the erythrocytes, due to the

Nail fold videocapillaroscopy in mixed cryoglobulinaemia.

Nail fold videocapillaroscopy (NVC) has been extensively used to examine morphological and functional changes of microcirculation in connective tissue diseases. The nutritional circulation that depends on tissue capillaries, can be expected to be significantly impacted in mixed cryoglobulinaemia (MC). Using NVC, we evaluated 29 patients with MC (19 women), mean age 66 years (range 40-83). They included 28 hepatitis C virus (HCV) positive patients-14 genotype 1b, 10 genotype 2a 2c, two genotype 4, two with undetermined genotype. Of them, 18 had type II (IgMk-IgG) MC and 11 had type III. All patients were symptomatic, presenting with weakness (24 of 29 patients), arthralgia (24), purpura (16), peripheral neuropathy (20), Raynaud's phenomenon (8), hypertension (19) and membranoproliferative glomerulonephritis (MPGN) (9). The nail fold capillaries of four fingers per hand were examined using a videomicroscope. Of the 29 patients, 27 had morphological abnormalities (including tortuosity and apical enlargement), 18 had capillaries with deeply altered orientations, 17 had shortened capillaries and 20 neoangiogenetic phenomena. These four types of capillary abnormalities were simultaneously present in 10, suggesting this combination to be a characteristic pattern in MC. Less common alterations included haemorrhages (10 cases), enlarged and giant capillaries (2) and avascular areas (2). The patients with MC-associated MPGN had a significantly greater number of capillary abnormalities (mean 4.5, range 4-6) than non-nephritic patients (mean 3.5, range 1-6, P = 0.01). The number of capillary abnormalities was not related to the presence of Raynaud's phenomenon. Microcirculatory changes did not correlate with other clinical manifestations or serological indices, including cryocrit, cryoglobulin type, HCV genotype, viral load, haemoglobin, ALT, rheumatoid factor, IgM and C4 levels. Patients with MC show a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, short capillaries and neoangiogenetic phenomena. Capillary changes are more numerous in nephritic patients.

Nailfold videocapillaroscopy in primary antiphospholipid syndrome (PAPS).

To evaluate microcirculatory changes (functional and morphological) in primary antiphospholipid syndrome (PAPS) patients. Thirty-one patients were examined using nailfold videocapillaroscopy (18 PAPS patients and 13 healthy subjects). The patients were subdivided into two subgroups, with lupus anticoagulant (n = 8) and with anticardiolipin (n = 10) antibodies. Capillary morphology was determined; diameters ( micro m) and functional capillary density (FCD, number capillaries/mm2) were measured in control conditions. Blood flow velocity (CBFV, mm/s) was also evaluated at rest and after release of 60 s arterial occlusion. The percentage of subjects with at least one morphological alteration in the observed capillaries was 77.8% for patients and 21.3% for healthy subjects. Capillary diameters ( microm) [afferent (AD), apical (APD) and efferent (ED)] were significantly smaller (mean +/- s.d.: AD-PAPS, 7.4 +/- 2.1; control, 9.1 +/- 2.6, P = 0.063; APD-PAPS, 11.6 +/- 2.3; control, 14.4 +/- 3.8, P = 0.015; ED-PAPS, 8.4 +/- 2.0; control, 10.9 +/- 3.2, P = 0.011) in PAPS patients compared with controls. FCD (PAPS, 8.5 +/- 3.2; control, 8.3 +/- 2.9, P +/- 0.862), mean resting CBFV (PAPS, 0.73 +/- 0.31; control, 0.88 +/- 0.41, P = 0.278), mean peak CBFV after occlusion (PAPS, 1.07 +/- 0.52; control, 1.59 +/- 0.91, P = 0.063) and mean time (s) to reach it (PAPS, 5.2 +/- 1.7; control, 4.6 +/- 1.8, P = 0.101) were not statistically different between the two groups. Our results suggest that nailfold capillary morphology is altered in patients with PAPS, but these changes could not be correlated to impairment of functional parameters.

Nailfold videocapillaroscopic patterns and serum autoantibodies in systemic sclerosis.

Microvascular lesions are a predominant feature in systemic sclerosis (SSc) and seem to play a central pathogenetic role. Recently, we graded scleroderma microangiopathy by nailfold videocapillaroscopy (NVC) into three NVC patterns (early, active and late). The aim of the present study was to confirm, in a larger number of SSc patients, the presence of three patterns of microvascular damage, and to detect any possible relationship between these patterns and both specific serum autoantibodies and the subsets of cutaneous involvement. Two hundred and forty-one consecutive patients (227 women and 14 men) affected by SSc were recruited. One hundred and forty-eight patients were affected by limited cutaneous SSc (lSSc) and 93 patients by diffuse cutaneous SSc (dSSc). The ages at onset of Raynaud's phenomenon (RP) and SSc, the durations of RP and SSc, ANA and antitopoisomerase I (anti-Scl70) and anticentromere (ACA) antibodies were investigated in all patients. The SSc patients were subdivided on the basis of the NVC pattern into three groups. A statistically significant correlation was found between the NVC patterns and the durations of both RP and SSc (P<0.001). Enlarged and giant capillaries, together with haemorrhages, constituted the earliest NVC finding in SSc (early NVC pattern). These abnormalities were mostly expressed in the active NVC pattern. Loss of capillaries, ramified capillaries and vascular architectural disorganization were increased in the late NVC pattern. Age and the duration of both RP and SSc were lower in 24 patients complaining of RP alone. Anti-Scl70 antibodies were statistically less frequent in the early vs both the active and the late NVC pattern, whereas no significant correlation was found between the presence of anti-Scl70 antibodies and the duration of either RP or SSc. ACA positivity was more frequent in patients with longer RP duration. Patients with lSSc had shorter SSc duration and showed the early or active NVC pattern more frequently. Conversely, patients with dSSc showed longer disease duration and mostly showed the late NVC pattern. NVC is an appropriate tool for differential diagnosis between primary and secondary RP through the clear recognition of the early NVC scleroderma pattern. This study confirms, in a large number of SSc patients, the existence of three distinct NVC patterns that might reflect the evolution of SSc microangiopathy. The presence of anti-Scl70 antibodies seems be related to earlier expression of the active and late NVC patterns of SSc microvascular damage. The presence of ACA seems to be related to delayed expression of the late NVC pattern.

Estudos morfológicos e funcionais da microcirculação da pele no diabetes mellitus

Os autores analisam os principais métodos de investigação morfofuncional da microcirculação da pele em diabéticos, tanto na literatura médica recente quanto na própria experiência em videocapilaroscopia subungueal, no âmbito dos atuais avanços do conhecimento sobre a fisiopatologia da microangiopatia diabética. Na videocapilaroscopia basal, feita na região periungueal das mãos, ressaltam a importância e a significativa prevalência das alterações morfológicas como edema, microaneurismas, tortuosidade e dilatação do segmento venoso capilar, tanto em indivíduos diabéticos quanto em parentes de 1º grau com testes de tolerância à glicose normais. Mostram o valor dos estudos das respostas dinâmicas da microcirculação à isquemia e a estímulos farmacológicos, observadas, sobretudo, por medidas de velocidade e/ou fluxo sangüíneo na videocapilaroscopia e dopplerfluxometria a laser, que, na maioria dos trabalhos, estavam alteradas em fases muito precoces da doença, por vasodilatação inadequada. São descritas as medidas do diâmetro e da área do segmento transverso capilar em videocapilaroscopia que podem ser úteis como parâmetros-respostas ao teste de isquemia reperfusão. Os autores discutem as bases da fisiopatologia que justificam as alterações observadas na videocapilaroscopia tanto basal como dinâmica.