Nailfold Capillaroscopy Abnormalities Correlate With Disease Activity in Adult Dermatomyositis

Abstract

Objectives: The aim of this study was to determine the relationship between disease activity in adult patients with dermatomyositis (DM) and other biomarkers of disease activity such as C-reactive protein creatinine kinase and nailfold video capillaroscopy (NVC).Methods: We performed a prospective single center study of 15 adult patients with DM. Study participants underwent two assessments at least 9 months apart including clinical, laboratory and NVC evaluations. Patients received immunosuppressive medications for their dermatomyositis, and ongoing disease activity was measured by the Myositis Intention to Treat Index (MITAX). NVC evaluation included assessment of capillary density, capillary apical diameter (mm), and the number of microhemorrhages per digit.Results: Microvascular abnormalities were present in most DM patients. Of these, capillary density (4.71 vs. 6.84, p = 0.006) and mean apical diameter (56.09 vs. 27.79 μm, p = 0.003) significantly improved over the study period in concordance with improving disease control (MITAX 8.53 vs. 2.64, p = 0.002). Longitudinal analysis demonstrated that capillary density was independently associated with MITAX (β = −1.49 [CI −2.49, −0.33], p = 0.013), but not other parameters such as C-reactive protein and creatinine kinase.Conclusions: Nailfold capillary density is a dynamic marker of global disease activity in adult DM. NVC may be utilized as a non-invasive point-of-care tool to monitor disease activity and inform treatment decisions in patients with DM.

Severe digital ischemia as an unrecognized manifestation in patients with antisynthetase autoantibodies: Case series and systematic literature review

“…The MITAX score at the onset of severe digital ischemia in patients classified as having PM/DM was comparable to the score of patients with "active disease" reported in previous studies. [50][51][52][53] Our findings stimulate further studies measuring antisynthetase antibodies in a large cohort of patients with severe digital ischemia regardless of underlying connective tissue diseases.…”

Nailfold capillaroscopy changes with disease activity in patients with inflammatory myositis including overlap myositis, pure dermatomyositis, and pure polymyositis

“…Recent studies also showed that there are inverse correlations between NVC scores and disease activity before treatment (n = 10) and that the density can Reumatologia 2022; 60/1 be a dynamic marker of global disease activity in adult patients (n = 15) with DM that can be improved after treatment [12,13].…”

“…There are some articles with limited numbers of patients for the evaluation of capillaroscopy in patients with OM [12,13], and a few articles pulling the patients with OM from patients with PM/DM to find the differences between these patients in their clinical and capillaroscopy features [14,15].…”

“…In some articles using Bohan and Peter criteria, there was no significant relationship between NFC score and disease activity [ 10 , 11 ], although some recent studies have shown the relationship of disease activity and capillaroscopy score and some improvements after treatment in adult patients with DM [ 12 , 13 ].…”

Evaluation of Coronavirus Disease-2019 Patients with Nailfold Capillaroscopy

“…NFC examination is a simple method that may be used to demonstrate microvascular changes in capillaries. In clinical practice, it is mostly used as a diagnostic method in patients with systemic sclerosis and dermatomyositis with Raynaud's syndrome 7,13 . In the literature, abnormal NFC have also been found in primary vasculitides such as Behçet's disease, Henoch-Schönlein purpura, Takayasu arteritis and granulomatous polyangiitis [14][15][16][17] .…”