The Significance of Nailfold Microvascular Changes in Connective Tissue Disease
Fatemah Baron, Rajneet Singh, Amina Gsel, John Carey and Bernadette Lynch
Rheumatology Department, University College Hospital Galway (UCHG)
Microangiopathy is an early sign in numerous autoimmune inflammatory diseases. Nailfold capillaroscopy (NFC) is the standard method for detecting peripheral microvascular abnormalities which has been found to be associated with certain connective tissue diseases (CTD).
The objective of the study is to prospectively investigate the diagnostic value of NFC in patients with CTD, to assess morphological and structural changes and to recognize useful microvascular features.
A prospective study was carried out in our department between February 2017 and July 2018. A detailed microscopic fingernail examination was performed on all fingers (except thumbs) by the same rheumatologist using video NFC. The images were interpreted by two rheumatologists. Different measurements were detected and analysed as outlined in Table 1. We excluded any patient who was not followed in our unit and/or did not have a diagnosis of a CTD.
44 patients were identified; 16 Undifferentiated CTD, 3 Mixed CTD, 14 Systemic Sclerosis (SSc), 5 Primary Sjogren Syndrome (pSS), 4 SLE, 1 Dermatomyositis and 1 vasculitis. 82% of patients were female. Based on the findings, avascularity was the commonest microvascular abnormality observed (63%) (Table 1). The obtained results were further categorized into normal pattern, nonspecific morphological abnormality (included abnormal morphology, haemosiderin deposition, infrequent dilated loops and avascularity) and SSc pattern (included frequent haemorrhage, giant capillaries, ramification and architectural distortion). 5 patients (11%) were categorised into a normal pattern, 22 patients (50%) were categorised into a nonspecific morphological abnormality and 17 (39%) were categorized into a SSc pattern group.
Among all abnormalities, avascularity is considered a non-specific microvascular change and it is reported in normal populations as well. Knowledge of nailfold changes in CTD is supportive of, but not diagnostic of, a CTD. Certain nailfold changes, particularly giant capillaries, frequent capillary haemorrhages and architectural distortion were significantly more frequent in disease groups. NFC should be employed routinely by all Rheumatologists in the course and follow-up of patients with CTD.