Nailfold Videocapillaroscopy Pattern Of Microangiopathy Research Articles

Progression of nailfold capillaroscopic patterns and correlation with organ involvement in systemic sclerosis: a 12 year study.

Objective: The aim of this observational study was to investigate the evolution of scleroderma microangiopathy throughout different nailfold videocapillaroscopy (NVC) patterns ('early', 'active', 'late') as well as the prevalence of organ involvement in SSc patients during a 12-year follow-up. Methods: Thirty-four SSc patients showing at baseline (first capillaroscopic analysis) the 'early' NVC pattern of microangiopathy were enrolled and followed for 12 years (s.d. 2). Complete NVC analysis and clinical and serological findings were collected. Patients were in a standard therapeutic care setting. Statistical analysis was carried out by non-parametric tests. Results: After a 12-year follow-up, the 'early' NVC pattern changed from baseline in 76% of the patients. The NVC pattern was found to be 'active' in 9 patients (26%), 'late' in 13 (38%) and characterized by non-specific capillary abnormalities in 4 (12%). In the subgroup whose microangiopathy progressed from the 'early' to the 'late' NVC pattern, the median time of progression from the 'early' to the 'active' pattern was significantly shorter (11 months) when compared with patients who progressed from the 'early' to the 'active' NVC pattern (55 months) (P = 0.002). The median time of progression between NVC patterns was significantly shorter in SSc patients showing either a nucleolar ANA pattern or Scl70 autoantibodies (P = 0.048). Organ involvement was progressively greater in SSc patients with 'early', 'active' and 'late' NVC patterns, respectively. Conclusions: This longitudinal study confirms over a 12-year follow-up the evolution of specific NVC patterns associated with the progressive severity of organ involvement in SSc patients in a standard clinical care setting.

Progression of nailfold capillaroscopic patterns and correlation with organ involvement in systemic sclerosis: a 12 year study.

The aim of this observational study was to investigate the evolution of scleroderma microangiopathy throughout different nailfold videocapillaroscopy (NVC) patterns ('early', 'active', 'late') as well as the prevalence of organ involvement in SSc patients during a 12-year follow-up. Thirty-four SSc patients showing at baseline (first capillaroscopic analysis) the 'early' NVC pattern of microangiopathy were enrolled and followed for 12 years (s.d. 2). Complete NVC analysis and clinical and serological findings were collected. Patients were in a standard therapeutic care setting. Statistical analysis was carried out by non-parametric tests. After a 12-year follow-up, the 'early' NVC pattern changed from baseline in 76% of the patients. The NVC pattern was found to be 'active' in 9 patients (26%), 'late' in 13 (38%) and characterized by non-specific capillary abnormalities in 4 (12%). In the subgroup whose microangiopathy progressed from the 'early' to the 'late' NVC pattern, the median time of progression from the 'early' to the 'active' pattern was significantly shorter (11 months) when compared with patients who progressed from the 'early' to the 'active' NVC pattern (55 months) (P = 0.002). The median time of progression between NVC patterns was significantly shorter in SSc patients showing either a nucleolar ANA pattern or Scl70 autoantibodies (P = 0.048). Organ involvement was progressively greater in SSc patients with 'early', 'active' and 'late' NVC patterns, respectively. This longitudinal study confirms over a 12-year follow-up the evolution of specific NVC patterns associated with the progressive severity of organ involvement in SSc patients in a standard clinical care setting.

Early Diagnostic and Predictive Value of Capillaroscopy in Systemic Sclerosis.

Nailfold microvascular impairment represents an early feature of systemic sclerosis (SSc) and its progression through different patterns of capillary damage and their validated scoring, is evaluable by nailfold videocapillaroscopy (NVC) in a safe and reliable manner. The presence of specific morphological microvascular alterations at the NVC (i.e., presence of giant capillaries) is fundamental and mandatory for the early diagnosis of SSc, together with the presence of the Raynaud's phenomenon. Furthermore, a recent longitudinal study showed a dynamic transition of microvascular damage through different NVC patterns of microangiopathy in almost 50% of SSc patients and clinical symptoms progressed in accordance with the NVC morphologic changes in 60% of the SSc patients. A pilot study was the first demonstrating an association between baseline NVC patterns and future severe, peripheral vascular and lung involvement with stronger odds according to worsening scleroderma patterns. Prognostic indexes for digital trophic lesions, especially for daily use in SSc clinics and simply limited to the mean score of capillary loss are now validated. Very recently, it has been described that efficacious potentially disease modifying therapies in SSc may interfere with progression of nailfold microvascular damage, as assessed by NVC, over long term at least in presence of digital ulcers. NVC is a safe and reliable tool for the early diagnosis of SSc and the different NVC scleroderma patterns have a predictive value for the clinical complications of the disease.

AB0782 Autoantibodies and nailfold capillaroscopic patterns in systemic sclerosis patients

BackgroundThree different and progressive patterns of nailfold microvascular damage are evident in systemic sclerosis (SSc) (1). The dynamic transition from “Early” to “Active” or to “Late” pattern was described in...

SP0045 The Prognostic Value of the Capillaroscopic Analysis

Structural capillary changes in systemic sclerosis (SSc) may be easily investigated and quantified by nailfold videocapillaroscopy (NVC), and in recent years there have been identified disease-specific progressive capillary abnormalities and...

SP0154 The Prognostic Value of the Capillaroscopic Analysis

Structural capillary changes in systemic sclerosis (SSc) may be easily investigated and quantified by nailfold videocapillaroscopy (NVC), and in recent years there have been identified disease-specific progressive capillary abnormalities and...

AB0487 Scoring the correlations between nailfold microangiopathy severity and finger dermal thickness in systemic sclerosis patients

BackgroundPeripheral microangiopathy and increased dermal thickness (DT) are typical clinical aspects of systemic sclerosis (SSc) (1-3).ObjectivesThe aim of this study was to identify and score possible correlations between nailfold microangiopathy...

AB0783 Dermal thickness, peripheral blood perfusion and nailfold microangiopathy in systemic sclerosis patients

BackgroundIncreased dermal thickness (DT), decreased peripheral blood perfusion (PBP), and nailfold microangiopathy are typical clinical aspects of systemic sclerosis (SSc) (1-3).ObjectivesTo investigate possible correlations between DT and both PBP degree...

AB0488 Nailfold videocapillaroscopy and laser speckle contrast analysis: in search of a correlation between microvascular damage and blood perfusion.

BackgroundMicrovascular impairment and decreased peripheral blood perfusion are typical aspects of systemic sclerosis (SSc) (1,2). It is not clear if there is a correlation between nailfold microangiopathy and blood perfusion...

Correlations between nailfold microangiopathy severity, finger dermal thickness and fingertip blood perfusion in systemic sclerosis patients

ObjectiveThe aim of this study was to identify possible correlations between nailfold microangiopathy severity, finger dermal thickness (DT) and fingertip blood perfusion (FBP) in systemic sclerosis (SSc) patients.MethodsFifty-seven SSc patients...

Timing of transition between capillaroscopic patterns in systemic sclerosis

To investigate the timing of transition through different patterns of nailfold microvascular damage in patients with systemic sclerosis (SSc). In this medium-term longitudinal study, 38 SSc patients (median disease duration 12 months) with the early scleroderma pattern of microangiopathy seen on baseline nailfold videocapillaroscopy (NVC) were followed up by NVC for a median of 84 months. The evolution of the NVC pattern over time was monitored and recorded. At the end of followup, the NVC pattern was still that of early scleroderma in 47% of the patients. The active scleroderma pattern was seen in 34%, the late scleroderma pattern in 13%, and a normal pattern in 5%. The mean± SD time of progression from the early to the active pattern and from the early to the late pattern was of 28 ± 20 months and 36± 29 months, respectively. In the subgroup of patients whose microangiopathy progressed from the early to the late NVC pattern, the time of progression from the early to the active pattern was only 8± 1 months (P = 0.01), demonstrating that there is a subset of patients with rapid progression of microangiopathy. Clinical symptoms progressed in accordance with the nailfold morphologic changes in 60% of the SSc patients. The results of this longitudinal study demonstrate dynamic transition of microvascular damage through different NVC patterns of microangiopathy in ∼50% of SSc patients. It is recommended that patients exhibiting rapid progression from the early to the active NVC pattern (<1 year) should be monitored closely, since the evidence suggests that they are at risk of rapid progression to the advanced (late) NVC pattern of microangiopathy that is associated with further clinical manifestations of SSc.

Response to: Comparison of laser Doppler imaging, fingertip lacticemy test, and nailfold capillaroscopy for assessment of digital microcirculation in systemic sclerosis

We read with interest the article by Correa and colleagues [1] in a recent issue of Arthritis Research & Therapy: 'Comparison of laser Doppler imaging, fingertip lacticemy test, and nailfold capillaroscopy for assessment of digital microcirculation in systemic sclerosis'. Using the laser Doppler imaging (LDI) technique, the authors found lower digital blood flow in systemic sclerosis (SSc) patients when compared with healthy controls. However, the authors did not discover any correlation between the functional (LDI) and morphological microvascular abnormalities, evaluated by nailfold capillaroscopy (NFC), suggesting that these techniques are complementary tools for the evaluation of independent microangiopathy aspects in SSc patients. The conclusions of the article may be controversial since these findings are in contrast with those of other recent reports that were not reported and considered in the authors' investigation. In particular, some recent studies described a correlation between fingertip blood perfusion (FBP), evaluated separately by LDI and laser Doppler flowmetry (LDF) techniques, and the extent of nailfold microvascular damage, as evaluated by nailfold videocapillaroscopy (NVC) [2-4]. The paper from Cutolo and colleagues [2] demonstrated a significantly lower FBP in SSc patients (P < 0.05) com-pared with controls, and this FBP was found to be partially reversible (increasing) after heating of the LDF probe at 36°C (P < 0.001), even if the slope of variation was significantly lower in SSc patients compared with controls (P < 0.05). Interestingly, SSc patients showing the 'late' NVC pattern of microangiopathy showed an FBP that was significantly lower than that of patients with the 'active' or 'early' NVC patterns (P < 0.05) [2,5]. In addition, a negative correlation between the FBP degree and the NVC rating (score) of the microvascular damage was observed (P < 0.05) [2,6,7]. Similar results were found by Rosato and colleagues [3], who described significantly lower mean blood perfusion in the hand/fingers of SSc patients characterized by the 'late' NVC pattern of microangiopathy when compared with patients showing the 'early' or 'active' NVC patterns. The authors concluded that the LDI and capillaroscopic images fully matched the definition of the various stages of the microvascular digital damage in SSc [3]. In the third study, again, SSc patients characterized by the 'active' or 'late' NVC patterns showed a red blood cell velocity that was more decreased (65.5% and 66.2% reduction, respectively) than that of patients sharing the 'early' pattern of microangiopathy [4]. This reduced red blood cell velocity was significantly associated with selected NVC morphological parameters, including capillary ramification and capillary loss that characterize the advanced microvascular damage (P < 0.01) [4]. In recent years, the morphological features identifying the SSc microvascular damage progression have been recognized. Consequently, microvascular lesions detected by NVC in patients with SSc have been classified according to the three different NVC patterns mentioned above (namely, 'early', 'active', and 'late'), which are clearly distinguishable from the 'normal' nailfold capillaroscopic pattern [5,8]. The 'early' pattern is characterized by the presence of a small number of giant capillaries and capillary micro-hemorrhages, no evident loss of capillaries, and relatively well-preserved capillary distribution. If the vascular disease progresses, an 'active' SSc pattern becomes evident: giant capillaries and capillary microhemorrhages increase and there is moderate loss of capillary, whereas ramified capillaries are absent or mildly branched and the capillary architecture is mildly disorganized. Finally, the 'late' SSc pattern becomes manifest in the more advanced stage of the vascular disease. This latter pattern is characterized by the absence of giant capillaries and microhemorrhages but shares severe loss of capillaries and the development of extensive avascular areas, together with ramified and bushy capillaries (indicative of neoangiogenesis) [5,8]. As a matter of fact, the different nailfold microvascular abnormalities are not all present at the same time but are expressed in a dynamic manner during the progression of the SSc microangiopathy [9]. For these reasons, when searching in SSc patients for a possible link between digital blood flow and nailfold capillary abnormalities without considering the dynamic evolution of these morphological markers, a lack of correlation may be expected. Obviously, further studies are needed to better understand whether the morphological nailfold capillary abnormalities are the cause or the effect (or both) of digital blood hypoperfusion in patients with SSc.

Panic disorder

<h3>Objective</h3> The aim of this study was to identify possible correlations between nailfold microangiopathy severity, finger dermal thickness (DT) and fingertip blood perfusion (FBP) in systemic sclerosis (SSc) patients. <h3>Methods</h3> Fifty-seven SSc patients and 37 healthy subjects were enrolled. All patients were evaluated by nailfold videocapillaroscopy (NVC) to classify and score the severity of microangiopathy. Both modified Rodnan skin score (mRss) and skin high-frequency ultrasound were used to detect finger DT. Laser Doppler flowmetry (LDF) was employed to detect FBP. <h3>Results</h3> A positive correlation was found between nailfold microvascular damage severity and both ultrasound-DT (p=0.028) and mRss values (p&lt;0.0001). In particular, both ultrasound-DT and mRss were found progressively higher in patients with ‘Early’, ‘Active’ or ‘Late’ NVC pattern of microangiopathy. A negative correlation was observed between nailfold microvascular damage severity and FBP (p&lt;0.0001), showing the lowest FBP of the patients with more advanced NVC patterns. A negative correlation was observed between FBP, and both ultrasound-DT (p=0.007) and mRss values (p=0.0002). SSc patients showed a higher ultrasound-DT at the level of the fingers, as well as a lower FBP than healthy subjects (p&lt;0.0001). <h3>Conclusions</h3> This study demonstrates a relationship between nailfold microangiopathy severity, DT and FBP in SSc patients.