Is there a difference in systemic lupus erythematosus with and without Raynaud’s phenomenon?

Abstract

The aim of this study was to assess the association between Raynaud's phenomenon (RP) and specific capillaroscopic findings in patients with SLE and particular clinical manifestations of the disease. A total of 79 patients with SLE were included in the study: 44 of them (43 women) with RP and 35 (32 women) age-, sex-, and disease-duration-matched patients with SLE without RP. Demographic variables, clinical manifestations, laboratory and nailfold capillaroscopy findings were compared between the two groups. Central nervous systemic involvements (P = 0.0038) and peripheral neuropathy (P = 0.0336) were significantly more common in SLE patients with RP, while secondary Sjögren's syndrome (P = 0.0363) was more common in SLE patients without RP. RP occurred in 52 % of patients before SLE onset while 48 % of patients developed RP after they had been diagnosed with SLE. Arthritis/arthralgia (P = 0.0073) was significantly more common in patients who had been diagnosed with RP before the onset of SLE, while mucosal ulcers were more common in patients who contracted RP after the onset of SLE (P = 0.0258). Enlarged capillaries (P = 0.0482), presence of avascular areas (P = 0.0476), capillary hemorrhages (P = 0.0482), and granular blood flow (P = 0.0482) were more common in patients with SLE who also suffered from RP, than in patients with SLE without RP. The frequency of normal (63.6 vs. 82.9 %, P = 0.100) and nonspecific (25 vs. 17.1 %, P = 0.5696) capillaroscopy findings were similar in either groups. Scleroderma-like pattern of capillaroscopy finding was only found in patients with RP [(11.4 %), P = 0.0482]. RP in our patients with SLE was associated with specific clinical manifestations, indicating that prognostic relevance of RP in SLE should be evaluated.

Position article and guidelines 2018 recommendations of the Brazilian Society of Rheumatology for the indication, interpretation and performance of nailfold capillaroscopy

“…In another study with SLE patients, NFC findings such as increased capillary tortuosity, avascular areas and microhemorrhages, were more common among the cases with RP compared to those without it (B) [35].…”

“…Capillary rarefaction and dilated loops are correlated with lung involvement (C) [34]. NFC abnormalities are more frequent among patients with SLE and RP (B) [35].…”

Capillaroscopy

“…Thus, 29% of an examined SLE collective displayed three alterations, 71% at least four alterations simultaneously . Nevertheless, in LE with Raynaud syndrome more SSc patterns are found . In other collagen–vascular diseases such as Sjögren syndrome, ‐antiphospholipid syndrome and mixed connective tissue disease (MCTD) findings are ‐similar .…”

Nailfold capillaroscopy: relevance to the practice of rheumatology

“…31 The presence of alterations in NFC is more frequent in patients with SLE presenting RP. 32 However, 50% of patients with SLE have normal NFC. SD pattern is a less common finding and has been described in 2-9% of patients.…”