Assessment of serum vascular endothelial growth factor and nail fold capillaroscopy changes in systemic lupus erythematosus with and without cutaneous manifestations

Abstract

Angiogenesis and microvascular endothelial injury play a role in the pathogenesis of systemic lupus erythematosus (SLE). Vascular endothelial growth factor (VEGF), a key regulator of angiogenesis, and nail fold capillaroscopy (NFC) have been investigated in few studies in SLE with no reports targeting SLE with cutaneous manifestations. To evaluate NFC changes and VEGF serum level in relation to disease activity in SLE patients with versus without cutaneous manifestations. Thirty SLE patients (15 with cutaneous manifestations [group I], 15 without [group II]) and 15 healthy controls were evaluated for VEGF serum levels, NFC changes and were related to disease activity. VEGF serum levels were significantly higher in patients than controls (median and interquartile range [IQR]: 2110.77, 471.09-4714.30 vs. 60.00, 14-366, respectively, P < 0.0001). VEGF cut-off value to predict SLE patients was more than 293 and to detect moderate and severe SLE activity was more than 422 pg/mL and more than 3800 pg/mL, respectively. Serum VEGF levels increased with increased disease activity (P < 0.05). It was significantly higher in group I than group II (median and IQR: 2624.74, 1801.39-4141.70 vs. 862.50, 180-2426.95, respectively, P < 0.05). Mean serum VEGF was significantly higher with NFC score 3 than 1 (P = 0.008). NFC score and SLE activity were significantly associated in patients (P < 0.05). Serum VEGF is significantly elevated in SLE patients with cutaneous manifestations and its cut-off values to detect different activity grades of SLE are identified. Abnormalities in NFC reflect the extent of microvascular involvement in SLE.

Correlations between angiogenic factors and capillaroscopic patterns in systemic sclerosis

“…Moreover, an inverse correlation between serum VFGF levels and capillary density has been reported [32,36]. The same findings have been observed in systemic lupus erythematosus: significantly higher VEGF serum levels have been detected in patients with decreased capillary density and neoangiogenesis (> 75% morphologically changed loops, as tortuous, enlarged, and/or disarranged capillaries) [37]. In addition, a prolonged overexpression of VEGF may have deleterious effects on the vascular network, because it may result in a chaotic vascular morphology with reduced blood flow in the newly formed vessels.…”

Ocular manifestations in systemic lupus erythematosus

“…The VEGF serum concentration in patients with SLE was significantly higher than healthy controls and may be a useful marker of disease activity and internal organ involvement in patients with SLE 89 90. Recently, anti-VEGF has been reported as a powerful tool for vaso-occlusion and vasculitis in patients with lupus.…”

Sonography of the Nail

“…Angiogenesis and microvascular endothelial injuries play a role in the pathogenesis of systemic lupus erythematosus [ 35 ] . The vascular changes also involve the digital arteries and nail bed.…”