Background Primary antiphospholipid syndrome (PAPS) is characterized by venous and arterial thrombosis, obstetric morbidity and the presence of antiphospholipid antibodies. The utility of nailfold videocapillaroscopy in conditions such as scleroderma (SSc) and primary Raynaud's phenomenon is well known. Whether patients with PAPS have specific findings in nailfold videocapillaroscopy is not well stablished.

Objectives To evaluate findings on nailfold videocapillaroscopy in patients with PAPS and their association with clinical and serological features.

Methods We prospectively included 26 PAPS patients according to the modified Sidney criteria and the Alarcόn-Segovia criteria for haematologic antiphospholipid syndrome, who regularly attend a tertiary referral center in Mexico City, and 15 healthy controls. We performed nailfold videocapillaroscopy according to the Cutolo technique (Optilia 200x) and obtained: capillary morphology, nonspecific abnormalities (tortuosity, crossed and dilated capillaries, capillary haemorrhages, neo-angiogenesis) and mean vascular density on 32 images per patient. We collected demographic, clinical (thrombosis, obstetric morbidity, non-criteria manifestations and comorbidities), serological (anticardiolipin antibodies, anti-β2 glycoprotein 1 antibodies and lupus anticoagulant) and treatment information. Analysis was performed used SSPS v.22, Chi square test was used to compare frequencies and Student's t test was used to compare means.

Results PAPS patients had higher frequency of at least 1 abnormal finding on videocapillaroscopy (77% vs 12%, p<0.009, OR=23, 95% CI=4–132), higher frequency of enlarged capillaries (69% vs 0%, p=0.0001, OR=33, 95% CI=3.8–295), lower frequency of “perfect normal” pattern (11.5% vs 56%, p=0.004, OR=0.1, 95% CI=0.02–0.48) than controls, and 8 patients (31%) showed changes compatible with the “early” SSc Cutolo pattern (<4 dilated capillaries/mm, <4 haemorrhages/mm, preserved architecture and no avascular areas). In PAPS patients, capillary haemorrhages were associated to neurologic manifestations (75% vs 14%, p=0.02, OR=19, 95% CI=1.4–248) and to comorbidity with hypertension (75% vs 14%, p=0.02, OR=19, 95% CI=1.4–248).

Conclusions PAPS patients frequently show at least one abnormality on videocapillaroscopy. The most frequent abnormalities are enlarged capillaries, microhaemorrhages and the presence of an “atypical normal” pattern. Capillary haemorrages are frequently found in patients with neurologic involvement of PAPS. The coexistence of hypertension or other comorbidities may contribute to the development of capillary abnormalities in PAPS patients.

References

1. Cutolo M, Pizzorni C, Tuccio M et al. Rheumatology 2004;43:719–726.

2. Ingegnoli F, Gualtierotti R Lubatti C, et al. Microvasc Res 2013; 90:90–95.

3. Vaz JL, Dancour MA, Bottio DA et al. Rheumatology 2004;43:1025–7.

References

Acknowledgements We wish to thank the Mexican College of Rheumatology for their support in the acquisition of the equipment used to perform this study.

Disclosure of Interest None declared