Nailfold capillary microscopy in healthy children and in childhood rheumatic diseases: a prospective single blind observational study

Abstract

Objectives: To develop an objective method of nailfold capillaroscopy (NFC), applicable to a wide age range of paediatric patients. To compare the morphological characteristics of the nailfold capillaries in different rheumatology patient groups and controls. Methods: A colour digital video camera attached to a stereomicroscope was used to capture nailfold capillary images. Computerised image processing was used to analyse and store data. Subsequent quantitative and qualitative morphological analysis was performed in the following paediatric patient and control groups: 18 children with connective tissue diseases (CTD: juvenile dermatomyositis, systemic sclerosis, and undifferentiated connective tissue disease), eight with systemic lupus erythematosus, nine with primary Raynaud's disease, three with primary vasculitis, 15 with juvenile idiopathic arthritis, 17 healthy children and 20 healthy adults. Images were analysed by a single assessor who was unaware of the patient details. Results: The NFC technique was simple to perform and gave reproducible results, although some intraand intersubject variation was noted. Capillary density and width was age related, with younger children having fewer and wider capillaries than older children and adults. Linear capillary density was significantly higher in healthy adults (mean (SD) 8.6 (1.6) capillaries/mm) compared with healthy children (HC 6.9 (0.9) capillaries/mm). The group with CTD had the most abnormal findings, with lower linear density (4.9 (1.7) capillaries/mm) and increased capillary loop width (10.7 (7.3) mm) compared with HC (3.5 (1.7) mm). In addition, 11/18 (61%) patients in the CTD group had more than two definitely abnormal capillaries in at least two nailfolds, an abnormality not seen in other subjects. Two qualitative measures, the degree of avascularity and general disarrangement of capillary pattern, were more commonly observed in the CTD group than in HC. The proportion of tortuous capillaries did not differ significantly between study groups. Conclusions: This study is unique in measuring objective quantitative and qualitative parameters of the nailfold vasculature across a wide spectrum of age and disease. Differences in capillary morphology and frequency in children with CTD compared with other paediatric diseases and healthy controls were demonstrated. In the clinical situation, an assessment of the general degree of disarrangement may offer a fast tool for assessment of the nailfold vasculature which correlates well with NFC data.

Impairment of microcirculation in juvenile idiopathic arthritis - studies by nailfold videocapillaroscopy and correlation with serum levels of sICAM and VEGF.

“…So far two reports only have addressed capillaroscopy assessment of microcirculation in a separate group of JIA patients [21,22]. Unlike in our study, Dolezalova et al did not reveal any significant differences in the capillary density, capillary width or the frequency of abnormal findings between a group of 15 JIA patients and healthy controls [21].…”

“…Unlike in our study, Dolezalova et al did not reveal any significant differences in the capillary density, capillary width or the frequency of abnormal findings between a group of 15 JIA patients and healthy controls [21]. In the second study, involving 55 children with JIA, the capillary number, size, shape and arrangements were found to be similar to healthy controls, also [22].…”

Capilaroscopia periungueal em crianças e adolescentes com doenças reumáticas

“…It is also used to distinguish primary from secondary Raynaud's phenomenon (RP), to predict the prognosis of AIRD (such as in systemic scleroderma -SSc), and to assess disease activity (such as in dermatomyositis). [1][2][3] NFC has proved to be very useful in the diagnosis of the scleroderma spectrum disorders in adults and children. The scleroderma pattern (SD-pattern), characterized by capillary dilation and avascular areas (vascular deletion), resulting in a reduction in the number of capillaries, is found in approximately 80% of the patients with SSc, but can also be seen in patients with dermatomyositis and mixed connective tissue disease (MCTD).…”

Nailfold capillaroscopy microscopy - an interdisciplinary appraisal

“…In these publications, age-related diff erences in various parameters have been noted. Thus, the defi nition of normal ranges of capillary microscopic features of adults does not seem to be appropriate for children [21].…”