Background Capillaroscopy is as a useful diagnostic tool in various connective tissue diseases characterized by microangiopathy and vasculitis.
Objectives The aim of our study was to investigate the impact of gender, clinical pattern and disease activity on capillaroscopic findings in patients with Lupus erythematosus (LE).
Methods 116 consecutive lupus patients (pts) of our center were prospectively examined, activity was scored by ECLAM and capillaroscopy pictures were taken in a standardized setting (digitus III-V of both sides, overview (7mm) and detail (1mm)). Capillarscopic features were compared with those of n=754 (normal controls (NP), scored by a blinded reader according to published criteria and documented in our web-based patient documentation application. Clinical disease patterns included systemic LE (SLE) with organ involvement (n=88, 75.9%), SLE with Overlap-Syndrome (n=16, 13.8%), oligosymptomatic LE (n=10, 8.6%), and cutaneous Lupus erythematosus (n=2, 1.7%). SPSS was used for statistical evaluation.
Results Predominantly women (w) were investigated (pts: n=98, 84.5%; NP: n=491, 65.1%). Pts’ mean age was 39.9±13.5 years (NP 54.6±17.1 years), mean disease duration 8.0±7.8 years, mean ECLAM score 2.1±2.3. Only 49% of the pts presented with normal capillary density (NP 96%), 45% had capillary hemorrhages (NP 10%), and 13% edema (NP 0.8%). Sludge phenomena were confirmed in 59% of the pts, w showed this phenomenon more often than men (m) (62 vs. 39%, NP 19 vs. 13%). Capillary filling was abnormal in 54% pts (NP 13%), with more reduced filling in w and more increased filling in m. Only 13% pts had no caliber variations (NP 99%). 49% of pts but <1% in NP had capillary ecstasies, w presented this feature more often than m. Other morphological changes were seen as follows: ramifications in 67% pts (NP <3%), and elongations 54% pts (NP <2%). Tortuous capillaries (TC) were seen in 64% pts (NP 18%), while m showed TC more and more often than w, these findings were also found in the NP. Although w showed different capillaroscopic changes than m, differences were not statistically significant. The clinical subgroup analysis showed SLE pattern in >70% of SLE with organ involvement, 56% of pts with overlap, 20% in oligosymptomatic LE but <1% in NP. Early scleroderma pattern were documented in 25%, active scleroderma pattern in 38%, and myositis pattern in >60% of overlap patients but <10% of others and <1% in NP. Patients with high disease activity (ECLAM >4, n=11) were rare and not matched, thus, robust data on the influence of high disease activity could not yet be derived from our sample.
Conclusions Compared to NP nail fold capillaroscopic changes are more frequent and severe in SLE, especially in those with organ involvement. Pts with clinical overlap also present an overlap pattern in capillaroscopy. The expression of disease activity on capillary pattern needs to be further evaluated in (longitudinal) trials. Gender-specific trends of capillaroscopic changes seen in NP are more pronounced in SLE. Capillaroscopic data might be evaluated gender-oriented in the future.
Acknowledgements Unrestricted grant: Pfizer Pharma GmbH, Germany
Disclosure of Interest None Declared