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AB0838 New aspects regarding microvascular abnormalities in systemic sclerosis
  1. S.N. Lambova1,2,3,
  2. U. Mueller-Ladner2
  1. 1Department For Propedeutics of Internal Medicine, Medical University, Plovdiv, Bulgaria, Plovdiv, Bulgaria
  2. 2Department for Internal Medicine and Rheumatology, Justus-Liebig University Giessen, Bad Nauheim, Germany
  3. 3Department for Rheumatology, MHAT “Health” MS “Palmed”, Plovdiv, Bulgaria

Abstract

Background In rheumatology, specific is the capillaroscopic pattern in systemic sclerosis (SSc) – the so-called “scleroderma-type”, which is characterized with giant capillaries, haemorrhages, avascular areas and neoangiogenesis. Three distinct subtypes of capillaroscopic changes are well-recognized – “early”, “active” and “late” phase scleroderma type capillaroscopic pattern.

Objectives The aim of the study was to evaluate the microvascular abnormalities in SSc with different disease duration as well as with the presence of digital ulcers.

Methods 36 SSc patients were included in the study, 30 patients with limited SSc, 5 with diffuse SSc and 1 with overlap syndrome, 30 females and 6 males, mean age 56±14 years. Nailfold capillaroscopy of the fingers was performed using a videocapillaroscope Videocap 3.0 (DS Medica).

Results RP was found as clinical symptom in 100% (36/36) of the examined SSc patients. “Scleroderma” type capillaroscopic pattern was found in 97.2% (35/36) of the cases. In81% ofthepatientsnonhomogeneityof the capillaroscopic pattern of the fingers was found. Capillaroscopicchangesfromdifferent phases were observed as well as an association with normal findings.In SSc patients with a duration of the disease less than 4 years, in 50% of the cases (5/10) an “early” phase “scleroderma” type capillaroscopic pattern was found, in 90% (9/10) – an “active” phase and in 10% (1/10) – a “late” phase. The following combinations of findings at different fingers were found – association of early and active phase, late and active phase, early phase and normal findings, active phase alone. In the group of SSc patients with duration of the disease - more than 5 years, in 26.9% (7/26) it was found a “late” phase “scleroderma” capillaroscopic pattern. In 80.7% (21/26) of the patients from this subgroup, an “active” phase “scleroderma” type capillaroscopic pattern was found, in 26.9% (7/26) - an “early” phase and in 3.8% (1/26) the images were not evaluated because of poor visualization. The following combinatons of findings were observed – late and active, early and active phase, active phase plus normal finding as well as early, active or late phase alone.Digital ulcers at the hands were present in 36.1% (13/36) of the SSc patients. In all of them (13/13), an “active” phase “scleroderma” pattern was observed at the finger with active digital ulcer. Normally, in the capillaroscopic reports the predominating pattern of the most of the fingers is described. Here, we present our results for the first type as an analysis of the findings of all the ten fingers of the patients.

Conclusions In conclusion, the data from the current study confirm the high frequency of the microvascular damage in SSc. But the capillaroscopic findings in SSc are nonhomogeneous. Thus, all the ten fingers of SSc patients should be examined. It has been also found, that a strong correlaton between the presence of digital ulcers and an active phase scleroderma type capillaroscopic pattern of the examined finger exists. The observation of an active phasesclerodermatypepattern in patients without digital ulcers may therefore be used in the future as a predictor for the development of trophic changes, an indicator for modulation of vasoactive treatment for prevention of development of digital ulcers and as an additional objective method for evaluation of the disease activity score in SSc.

Disclosure of Interest None Declared

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