Background The diseases of social importance such as arterial hypertension (AH) and diabetes mellitus (DM) are frequent concomitant pathology in patients with rheumatic diseases. At present, the capillaroscopic findings in these entities are not well-defined.
Objectives The aim of the study is to analyze and juxtapose the capillaroscopic findings in some common rheumatic diseases with those in AH and DM.
Methods In the study were included patients from the following groups e. g., 36 patients with systemic sclerosis (SSc), 30 patients with systemic lupus erythematosus (SLE), 31 – with undifferentiated connective tissue diseases (UCTD). The capillaroscopic findings were analyzed and juxtaposed with those in 34 patients with AH and 22 – with DM without signs of systemic rheumatic diseases as well as with healthy controls group. Nailfold capillaroscopy was performed with videocapillaroscope Videocap 3.0 (DS Medica, Italy).
Results “Scleroderma” type capillaroscopic pattern, which is a reference pattern in rheumatology and is characterized with presence of giant capillaries, haemorrhages, avascular areas, neoangiogenesis, was found in 97.2% (35/36) of SSc cases. A correlation between capillaroscopic changes and the disease duration was observed (p<0.05). In SSc patients with disease duration below 3 years, an “early” phase, “scleroderma” type capillaroscopic changes with dilated capillary loops, single giant capillaries and haemorrhages were found in 50% of cases. A “late” phase, “scleroderma” type capillaroscopic findings with avascular areas and neoangiogenic capillaries were observed in SSc patients with longer disease duration. “Scleroderma-like” capillaroscopic pattern was detected in 13.3% of SLE patients and in 38% of UCTD cases respectively. Such microvascular features were not observed in patients with AH and DM. In essential AH, a significant lower mean capillary density was found as compared with healthy volunteers as the findings were not associated with presence of avascular areas, which suggests that the microvascular changes in AH are primary. In DM with long disease duration minimal microvascular changes were detected such as slightly dilated capillary loops and increased tortuosity. In 4 patients from DM group, a stiff hand syndrome, skin thickening of the fingers or sclerodactyly was found. All of these patients with rheumatic-like features presented with a normal capillaroscopic picture.
Conclusions The most specific capillaroscopic findings in the early stages of rheumatic diseases is capillary dilation with appearance of megacapillaries and haemorrhages formation, while capillary loss is evident in the advanced stages. Capillaroscopic features characteristic of systemic rheumatic diseases were not observed in AH and DM. Moreover, significantly lower mean capillary density, which is not associated with presence of avascular areas, is suggested to be a primary feature of AH that probably predate the development of the disease. Interestingly, DM patients with long diseases duration present with minimal capillaroscopic abnormalities and in even in cases with rheumatic-like manifestations a normal capillaroscopic pattern could be found.
Disclosure of Interest None declared