Inhomogeneity of capillaroscopic findings in systemic sclerosis

Lambova, Sevdalina Nikolova; Müller‐Ladner, Ulf

doi:10.1111/1756-185x.13760

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…3, 4, 5, 6). Considering capillary inhomogeneity at different fingers, the most advanced capillaroscopic changes that were registered are documented as a final conclusion [35].…”

Section: Resultsmentioning

confidence: 99%

“…Considering the localized and focal microvascular changes in some cases (at single finger and in focal areas of the nailfold), using of higher magnification i.e., 200x without detailed examination of the whole length of nailfold and all fingers might lead to misdiagnosis [35,39]. Radic et al (2020) have evaluated the role of dermatoscopy as a screening tool in RP patients in rheumatology in comparison to videocapillaroscopy.…”

Section: Discussionmentioning

confidence: 99%

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The utility of USB microscope for assessment of Raynaud’s phenomenon patients in rheumatology practice

Lambova,

Stoilov,

Boyadzhieva

2024

RBJ

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The aim of the study was to assess the utility of USB microscope (DinoLite) for evaluation of patients with primary and secondary Raynaud’s phenomenon (RP) in rheumatic diseases, , using magnification 200x. Methods: The study represents retrospective analysis of capillaroscopic images of 53 patients with RP – primary and secondary in the context of systemic sclerosis (SSc) or other rheumatic diseases i.e., undifferentiated connective tissue disease (UCTD), prescleroderma and systemic lupus erythematosus (SLE). Capillaroscopic images are obtained from 8 fingers (II÷V bilaterally) using USB microscope (DinoLite) at magnification 200x. Capillary diameters were measured (arterial, venous and apical loop) as well as the number of capillaries per millimeter and capillary length. The capillaroscopic images were categorized into the following groups i.e., 1. absence of microangiopathy: i) normal pattern, ii) nonspecific changes; 2. presence of microangiopathy i.e., “scleroderma/ scleroderma-like” pattern. Results: Images suitable for analysis with good visibility that permit analysis of the major capillaroscopic parameters were available in all patients (100%). Among 53 included patients, 14 patients were with SSc, 12 cases with primary RP, and 27 patients with secondary RP in other connective tissue diseases (22 patients with UCTD, 1 – with prescleroderma and 4 patients with SLE). „Scleroderma“ pattern was detected in 11 patients with SSc and in all these cases the capillaroscopic images were classifiable into one of the three distinct validated phases i.e., “early”, ”active” and ”late”. Presence of microvascular changes type “scleroderma-like” pattern was detected also in 17 among 27 patients with other connective tissue diseases. In primary RP patients, capillaroscopy revealed either normal pattern or nonspecific findings, but without features of microangiopathy. Conclusion: Capillaroscopic images of good quality, which could be analyzed and interpreted, are usually obtained using USB microscope. This permits evaluation of the major capillaroscopic parameters including quantitative measurement of the capillary diameters, capillary density and length. Assessment of the degree of microvascular changes i.e., staging of microangiopathy is also applicable and was possible in all cases with microangiopathy. The available software although less sophisticated vs those of videocapillaroscopes, providess the opportunity for adequate analysis of capillaroscopic parameters. The images obtained via USB microscope using magnification 200x are easily classified into “scleroderma”/“scleroderma-like” pattern, non-specific changes and normal findings using also the software of the device. Thus, USB microscopes using standard, 200x magnification could be suggested as an alternative of videocapillaroscopes in every day rheumatology practice especially in low-budget cases.

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“…3, 4, 5, 6). Considering capillary inhomogeneity at different fingers, the most advanced capillaroscopic changes that were registered are documented as a final conclusion [35].…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The utility of USB microscope for assessment of Raynaud’s phenomenon patients in rheumatology practice

Lambova,

Stoilov,

Boyadzhieva

2024

RBJ

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“Scleroderma” and “Scleroderma-like” Capillaroscopic Pattern-Differences and Similarities

Lambova,

Müller-Ladner

2024

CRR

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Introduction: The “scleroderma” type capillaroscopic pattern is a reference pattern in rheumatolo-gy that is a diagnostic sign for systemic sclerosis (SSc) in an appropriate clinical context and is observed in more than 90% of scleroderma patients. Similar microvascular changes, the so-called “scleroderma-like”, have been described albeit in a lower proportion of patients with other rheumatic diseases, such as derma-tomyositis (DM), undifferentiated connective tissue diseases (UCTD), systemic lupus erythematosus (SLE), etc. Three distinct stages of “scleroderma” pattern have been suggested by Cutolo et al., i.e., “early”, “active”, and ”late”. However, disease duration is just one of the factors that contributes to the progression of micro-vascular changes, and in this regard, “active” or even “late” pattern could be observed in patients with shorter disease duration. In addition, stable microvascular changes could be found for long periods in other cases. Objective: The aim of the study was to assess the presence of differentiating features between “scleroderma” pattern in SSc and “scleroderma-like” pattern in other rheumatic diseases. Methods: 684 capillaroscopic images demonstrating a “scleroderma” and “scleroderma-like” pattern have been analysed in the current retrospective cross-sectional study. 479 capillaroscopic pictures were obtained from 50 SSc patients, 105 from 7 DM patients, 38 from 10 rheumatoid arthritis (RA) patients, 36 images from 5 patients with SLE, and 26 images from 9 patients with UCTD. All capillaroscopic images used in the cur-rent analysis have fulfilled the criteria for “sclerderma/scleroderma-like” pattern, as the pathological changes in the capillaroscopic parameters have also been confirmed by quantitative measurement of capillary diame-ters, capillary density, and intercapillary distance. All the images have been categorized into one of the fol-lowing groups, i.e., “early”, “active” and “late” phases (according to the definition of Cutolo et al.), or “other” findings, the latter being specifically described as they could not be attributed to one of the other three catego-ries. Results: 479 capillaroscopic pictures were obtained from 50 scleroderma patients. 31 of them showed an “ear-ly”, 391 an “active” phase, and 57 a “late” phase “scleroderma” type microangiopathy. In 69 images assessed as an “active” pattern, neoangiogenesis was found. In 43 out of 105 capillaroscopic pictures from DM pa-tients, an “active” phase was detected; in 2 of the images, a “late” pattern was found, and in 60 capillaroscopic pictures, neoangiogenesis in combination with giant capillary loops was observed. Early microangiopathy was not found in this group. Among capillaroscopic images from SLE patients, “late” phase microangiopathy was not found. “Early” phase was present in 3 images, “active” phase in 29, neoangiogenesis in “active” phase in 4 pictures. Early microangiopathy was detected in 11 capillaroscopic pictures from RA patients (8 out of 9 patients), an “active” phase in 4 images (3 patients), and in 23 capillaroscopic images, neoangiogenesis with mild capillary derangement and capillary loss and single giant capillaries (“rheumatoid neoangiogenic pat-tern”) were observed. Classic “late” type microangiopathy was not found in RA patients as well as among pa-tients with UCTD. The predominant capillaroscopic pattern in UCTD patients was early microangiopathy (n = 23). The rest images from UCTD exhibited features of the “active” phase. Conclusion: In conclusion, early microangiopathy was observed in RA, SLE, and UCTD patients, but not in patients with DM. An “active” phase “scleroderma” type capillaroscopic pattern was detected in all patient groups other than SSc, i.e., DM, SLE, RA, and UCTD. “Late” phase “scleroderma” type microangiopathy was present in patients with scleroderma and DM and was not observed in SLE, RA, and UCTD. Despite the fact that in some cases, microangiopathy in scleroderma and other rheumatic diseases may be indistinguisha-ble, the results of the current research have shown the presence of some differentiating features between “scle-roderma” and ”scleroderma-like” microangiopathy that might be a morphological phenomenon associated with differences in the pathogenesis and the degree of microvascular pathology in various rheumatic diseases.

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The Value of Nailfold Capillaroscopy in the Classification and Differential Diagnosis of Raynaud’s Phenomenon in Rheumatology

Lambova

2024

CRR

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Among instrumental techniques, nail fold capillaroscopy plays a leading role in the assessment of Raynaud’s phenomenon (RP) patients because it is the only method that provides opportunities for morphological assessment of capillaroscopic findings in the nail fold area, with proven diagnostic and prognostic significance in rheumatology.The discussion over updating the classification of RP in rheumatology is interesting given the current understanding of capillaroscopic findings in rheumatic diseases and improvements in immunological diagnostics. The presence of dilation of the “true” capillary diameters in primary RP could be observed.There are some cases of primary RP where the capillaroscopic pattern is completely normal and there are no dilated capillaries present, which could be related to the duration and severity of the symptoms. It is possible that longer duration and greater severity are associated with the appearance of capillary dilations, but more research is needed to confirm it. Rarely, pathological capillaroscpic features of microangiopathy could be observed in RP patients in whom clinical, laboratory and immunological findings are compatible with the diagnosis “primary RP”. These cases should be defined as “suspected secondary RP” and require closer follow-up for the assessment of symptom evolution. Abnormal “scleroderma” type capillaroscopic pattern has been established as a new classification criterion for systemic sclerosis (SSc) in 2013. Similar changes (“scleroderma-like” pattern) could be observed in other rheumatic diseases, i.e., undifferentiated connective tissue disease (UCTD), systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, including without evidence of overlap with scleroderma. The appearance of such microvascular abnormalities at disease presentation is less well studied in diseases different from SSc. However, “scleroderma-like” microangiopathy has also been reported as an initial sign in some systemic rheumatic diseases, such as UCTD and systemic lupus erythematosus. Thus, interpretation of capillaroscopic findings is performed in overall context, including clinical findings and laboratory and immunological test results.

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Inhomogeneity of capillaroscopic findings in systemic sclerosis

Cited by 4 publications

References 22 publications

The utility of USB microscope for assessment of Raynaud’s phenomenon patients in rheumatology practice

The utility of USB microscope for assessment of Raynaud’s phenomenon patients in rheumatology practice

“Scleroderma” and “Scleroderma-like” Capillaroscopic Pattern-Differences and Similarities

The Value of Nailfold Capillaroscopy in the Classification and Differential Diagnosis of Raynaud’s Phenomenon in Rheumatology

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