Capillaroscopy in Psoriatic and Rheumatoid Arthritis: A Useful Tool for Differential Diagnosis

Abstract

Impairment of capillaries permeability and changes of microcirculation are associated with inflammatory arthritis. In order to demonstrate microvascular differences between psoriatic arthritis (PsA) and rheumatoid arthritis (RA) we analyzed capillaroscopic abnormalities such as megacapillaries, haemorrhages, ramifications, and avascular areas in patients affected by these two rheumatic disorders. Moreover to identify specific capillaroscopy patterns we analyzed the following parameters: venous limb diameter, arterial limb diameter, capillary loop diameter, amplitude of the capillary loop, linear density of capillaries (on 2 mm), and number of twisted capillaries (on 4 mm). Through a comparative morphometric analysis of capillaroscopy, our study demonstrated the presence of specific microvascular differences between PsA and RA providing an additional diagnostic tool for the differential diagnosis. We also suggest that capillaries structural abnormalities might reflect endothelial injury due to systemic inflammation during chronic arthritis.

Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis

“…Although the pathogenesis of nail fold vascular changes in RA is still not completely clear, it has been supposed that inflammation may play a key role . The results of our dermoscopic study are consistent with what was demonstrated by videocapillaroscopy, with obvious differences related to the diverse magnification used in these two techniques (×10 for manual dermoscopy and ×50–1000 for videocapillaroscopy) . In particular, it is possible to speculate that the absence of normal capillary loops in our PsA and RA patients likely reflects the reduction in capillary density/size visible using capillaroscopy, while the presence of sparse dotted vessels in PsA and parallel small vessels/irregular, ramified, blurry, purple vessels in RA could respectively correspond to coiled capillaries and short parallel loops in a fish school‐like pattern/subpapillar venous plexus visibility detectable at higher magnification.…”

“…Microvascular involvement may represent an early abnormality in both PsA and RA, with possible abnormalities of the vessels of synovial membrane, skin and/or nail fold . Over the last years, nail fold vascular plexus changes have been widely investigated by videocapillaroscopy in both these conditions .…”

“…avascular areas/decreased density of loops and nail involvement, reduction in capillaries size and distal interphalangeal joint arthritis, and decreased density of loops and mutilating PsA), but in most cases such speculations have not been confirmed . Nail fold vascular modifications in PsA are thought to be the result of changes in normal angiogenesis, inflammatory damage of the vessels, loss of normal binding between endothelial cells and matrix of papillary dermis, and/or sympathetic vasoconstrictor reflexes due to pain and/or limb use . Regarding RA, while some studies excluded the presence of specific alterations in this condition, other more recent analyses found various capillaroscopic alterations, including tortuous/ramified capillary loops, short parallel loops in a fish school‐like pattern, elongated/tiny loops, microhemorrhages, capillary low density and subpapillar venous plexus visibility .…”

“…Microvascular involvement may represent an early abnormality in both PsA and RA, with possible abnormalities of the vessels of synovial membrane, skin and/or nail fold. 10,11 Over the last years, nail fold vascular plexus changes have been widely investigated by videocapillaroscopy in both these conditions. 6,[10][11][12][13][14] In particular, several alterations have been reported in PsA, with lower capillary loop density, reduction in arterial/ venous capillary limb diameters, increased avascular areas and presence of coiled/tortuous capillaries being the most significant features.…”

Capillaroscopic patterns in patients with systemic sclerosis, psoriasis and alopecia and their correlations with serum concentrations of several angiogenic markers

“…a diminution in the capillary bed density in the nailfold of psoriatic patients with associated nail changes or DIP (distal interphalangeal predominant) joint disease [24]. The same authors were also of the opinion that NVC could be helpful in differentiation between PsA and rheumatoid arthritis (RA) in which the venous, arterial and loop diameters were significantly higher than in PV, PsA and controls [29].…”