Background NFC allows for the detection of changes in microcirculation characteristic of connective tissue diseases. Sistemic Sclerosis is one of the diseases most recognized as presenting alterations in the microcirculation. Differences have been found between the capillaroscopic findings in healthy adults and the capillaroscopic findings in children: more visible subpapilar venous plexus, lower capillary density and more tortuosity. Currently there is no defined capilaroscopic pattern in JIA.
Objectives identify the capillaroscopic pattern in children and adoloscents with JIA and asses its relationship with JIA forms.
Methods Medical records of patients less than 18 years old were reviewed. Demographic and clinical variables of each patient were recorded. We identified 14 patients, current mean age of 11.35, and predominantly female. The number of patients with each JIA form were: 5 oligoarticular, 3 polyarticular, 3 related enthesitis, 2 chronic monoarthritis and 1 psoriatic arthritis. Two patients had antinuclear antibodies (ANA), one of them with persistent oligoarticular JIA with uveitis, and 2 were HLA B27 positive (enthesitis related arthritis and monoarticular), all were rheumatoid factor negative. None of the children had Raynaud’s phenomenon. NFC was carried out by the same rheumatologist, on fingers 3 through to 5 of both hands using a ZUZI videocapillaroscopy, trinocular, dual illumination and zoom of 1 X 4 X.
Results Microvascular alterations were found in 12 patients. All had tortuous capillaries, 4 had bushy morphology and 1 with twister morphology. Venus plexus was very visible in 9 patients. Dilated capillaries were found In 6 patients: in 5 with grade 1 (less than three times the normal size) and 1 with grade 2 (between 3 and 10 times normal). The dilation was 50% of the efferent loop and 50% the total capillary. 6 patients showed a lower density of capillaries. When analyzing the data by JIA forms, we found that in the oligoarticular and enthesis related forms the capillary dilation is more frequent. In the oligoarticular form we found less capillary density.
Conclusions In JIA, only nonspecific changes have been described, such as tortuosity and elongation of capillaries, microhemorrhages and increased venular plexus visibility. These changes are more frequent in polyarticular JIA and patients with positive RF or ANA.
In the overall assessment of our series, we found morphological alterations in all the patients, high visibility of subpapilar venous plexus and a disorganized periungueal area in the majority of the patients regardless of JIA form. In all children with polyarticular and enthesitis related forms, capillary dilation was observed. No increase in microvascular alterations in children with ANA + was found.
Thus, our study confirms the existence of nonspecific capillary changes in JIA and highlights the possibility that capillary dilation is a specific finding in polyarticular and enthesitis related forms. Due to the limited number of patients in the sample, we will need to conduct further studies with more patients in order to clarify these findings.
References Piotto et al. Nailfold capillaroscopy in children and adolescents with rheumatic diseases. Rev Bras Reumatol 2012;52(5):722-73
Disclosure of Interest None Declared