Decreased nailfold capillary density in Raynaud's phenomenon: a reflection of immunologically mediated local and systemic vascular disease?

Abstract

SUMMARY Nailfold capillary patterns were studied in 107 patients with Raynaud's phenomenon (RP), including patients with (n=39) and without (n=68) connective tissue disease (CTD). Capillary density was decreased in patients with sclerodactyly, digital ulcers, tuft resorption, and telangiectasia, compared with patients without these symptoms. In addition, an inverse relationship was found between the severity of RP at first presentation (as graded by photoelectric plethysmography during cooling) and the capillary density in patients with CTD (r= -0-45; p<005). In the total group of patients nailfold capillary density was inversely related to organ system involvement (r= -0-52; p<0-01). Decreased nailfold capillary density was observed, in particular, in patients with oesophageal hypomotility and in patients with chest x-rays compatible with interstitial fibrosis. As to factors supposedly involved in the pathogenesis of vascular changes in CTD, the presence of autoantibodies, increased levels of circulating immune complexes, and increased levels of acute phase reactants were all associated with a decreased number of nailfold capillaries. We conclude that loss of nailfold capillaries as observed by microscopy is a reflection of local and systemic vascular disease.

Are Nailfold Capillary Changes Indicators of Organ Involvement in Progressive Systemic Sclerosis?

“…Pattern and frequency of widefield nail fold capillary changes in patients with PSS were similar to those described previously [1,2,4,7,9,11], Two of these studies could not demonstrate a relationship between capil lary changes and organ involvement [11,12]. Lovy et al [11] reported a correlation be tween extreme capillary loss and mean dura tion of the disease, but without a significant correlation between the presence or the severity of capillary enlargement and the ex tent of organ involvement in 42 patients [12].…”

“…In contrast, 3 other former studies disclosed a correlation between capillary en largement or loss and organ involvement and appearance of ANA. In the opinion of these authors, these nailfold capillary changes mirror a systemic vascular disease [5,12,13]. In our patients, we found a high correla tion between capillary enlargement or loss and visceral involvement or immunological findings.…”

“…Lovy et al [11] reported a correlation be tween extreme capillary loss and mean dura tion of the disease, but without a significant correlation between the presence or the severity of capillary enlargement and the ex tent of organ involvement in 42 patients [12]. On the other hand, the presence of telangiectasias did correlate with the presence and severity of nailfold capillary enlarge ment.…”

Capilaroscopia periungueal pode sugerir atividade de doença pulmonar na esclerose sistêmica

“…Apesar de diversos estudos relatarem associação da dilatação capilar ou desvascularização na CPU com lesões em órgãos internos (5,(8)(9)(10)(11)(12)(13)(14)(15)(16) , outros falharam em reproduzir esses achados (4,17,18,22) . A ampla variabilidade nos resultados devese possivelmente a diferenças amostrais e a diferentes métodos de aferição de alterações clínicas e da CPU.…”

“…Diversos estudos tentaram associar a presença ou severidade de alterações capilaroscópicas com lesões em órgãos-alvo na ES, obtendo resultados variáveis (4,5,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Nenhum desses estudos tentou associar os achados capilaroscópicos com alterações na tomografia computadorizada de alta resolução (TCAR) pulmonar, que é um método muito mais sensível e precoce do que a radiografia de tórax para a detecção de doença intersticial pulmonar (19) .…”