Background Nailfold videocapillaroscopy (NVC) abnormalities have been reported in patients with Rheumatoid Arthritis (RA). Nevertheless only few studies evaluated the grades of the detected alterations (1,2). In 1994, Hachulla et al., showed microvascular permeability alterations in RA, to confirming the existence of a microangiopathy (3). In addition, Meyer et al. showed modifications of the normal blood flow velocity and microvascular dysfunction in RA (4).
Objectives The aim of this study was to evaluate, in RA patients and healthy controls (HC), the microcirculatory abnormalities through NVC, applying a qualitative and quantitative method. We also correlated abnormalities with clinical and immunological features
Methods Thirty-five HC (35 females, 7 males, median age 55, range 32–70) and 70 RA patients (61 females, median age 58 years, range 30–75; median disease duration 12 years, range 1–20) consecutively admitted to our outpatient clinic, were examined. All patients underwent a full clinical-serological characterization. Both patients and controls underwent NVC, with optical probes of 200X (VideoCap 2.5).
We excluded patients who showed conditions known to compromise microcirculation, such as diabetes, hypertension, overlap with other connective tissue diseases or certain pharmacological treatments. The following NVC parameters were evaluated with a semiquantitative method: capillary enlargement (ectasias), microhemorrhages, mean capillary density, capillary tortuosity (5).
Results NVC alterations were detected in 55 of 70 (68.6%) RA patients: 40 (57%) patient showed ectasic capillaries; 21 (30%) decrease of the mean capillary density; 12 (17%) microhemorrhages; 46 (65.7%) capillary tortuosity. No patient had megacapillaries and/or neoangiogenic abnormalities.
A statistically significant difference between HC and RA patients was found for the detection of ectasias (p<0,0001) and for the decrease of the mean capillary density (p<0,001).
No differences emerged in RA patients between NVC pattern and/or immunological (ANA, ACPA, Rheumatoid Factor) and/or serological profile (ESR, CRP, lipid profile).
Nevertheless we found a correlation between NVC abnormalities (microhrmorrhages) and activity disease evaluated by DAS28 (p=0.0037)
Conclusions Our study confirms the presence of a sub-clinical microvascular involvement in RA patients either with or without microvascular clinical manifestations.
In our opinion capillaroscopy can be considered a valid technique in inflammatory joint diseases to analyze microvascular circulation. Moreover, the correlation of NVC specific alteration with disease activity suggests the importance of these features in the assessment of RA patients.
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Hachulla et al, J Rheumatol 1994.
Meyer. Rheumato Int 2007.
Ingegnoli et al,Seminar Arthitis Rheum 2009.
Disclosure of Interest None declared