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Bilancini S, Lucchi M, Tucci S, Pomella F, Vittori G, Mollo PE, Trevisan G. Red Palms' Syndrome and Red Fingers' Syndrome: A Mini Review. Angiology 2023:33197231185459. [PMID: 37410889 DOI: 10.1177/00033197231185459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Red palms syndrome consists of an intense redness on the palms of the hands and, occasionally, the soles of the feet. This infrequent condition may be primary or secondary. The primary forms are either familial or sporadic. They are always benign and do not require treatment. The secondary forms may have a poor prognosis related to the underlying disease, for which early identification and treatment are imperative. Red fingers syndrome is also rare. It manifests as a persistent redness on the fingers or toes pulp. It is typically secondary either to infectious diseases like human immunodeficiency virus, hepatitis C virus and chronic hepatitis B or to Myeloproliferative Disorders, such as Thrombocythemia and Polycythemia vera. Manifestations spontaneously regress over months or years without trophic alterations. Treatment is limited to that of the underlying condition. Aspirin has been shown effective in Myeloproliferative Disorders.
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Affiliation(s)
| | - Massimo Lucchi
- Institute of Angiology Jean Francois Merlen, Frosinone, Italy
| | - Sandro Tucci
- Institute of Angiology Jean Francois Merlen, Frosinone, Italy
| | - Federica Pomella
- Department of Angiology, ASL Frosinone (Local Unit of the National Health Service), Frosinone, Italy
| | - Giulia Vittori
- Institute of Angiology Jean Francois Merlen, Frosinone, Italy
| | | | - Giusto Trevisan
- Department of Medical Sciences, University of Trieste, Trieste, Italy
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Wang L, Chen H, Ding Z, Ma L, Sun Y, Jiang L. Associations of microcirculation damage on nailfold capillaroscopy with supra-aortic severe ischemic events in patients with Takayasu arteritis. Clin Rheumatol 2023; 42:1625-1634. [PMID: 36787036 DOI: 10.1007/s10067-023-06527-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To evaluate the clinical characteristics and nailfold microcirculation and explore the associations with severe ischemic events (SIEs) in Takayasu arteritis (TA) with supra-aortic involvement. METHODS Eighty-one patients with supra-aortic artery involvement who underwent nailfold video-capillaroscopy (NVC) of their hands were enrolled from the East China TA (ECTA) cohort between August and December 2021. Clinical features and capillaroscopy variables associated with supra-aortic SIEs were analyzed by multivariate logistic regression. RESULTS Overall, 71 patients were female, and 42 experienced supra-aortic SIEs, among whom there was a higher prevalence of hypertension and the number of supra-aortic artery stenosis (P = 0.005, and 0.003, respectively). Furthermore, intergroup differences in capillary density (P < 0.001) and minor morphology abnormalities (P < 0.001) were significant. After adjustment for all confounders, multivariate logistic regression revealed hypertension (odds ratio [OR]: 7.3, 95% confidence interval [CI]: 1.6-33.7, P = 0.011), the number of supra-aortic arteries stenosis (≥4, OR: 6.8, 95% CI: 1.4-34.6, P = 0.020), capillary density (≤7.2/mm, OR: 43.0, 95% CI: 7.0-264.6, P < 0.001) and minor abnormalities (OR: 34.2, 95% CI: 3.6-325.1; P = 0.002) were independent risk factors for supra-aortic SIEs. capillary density (≤7.2/mm) and minor abnormalities or combined with at least two of the three items in the matrix model showed the probability of supra-aortic SIEs was 61.2-87.6%. CONCLUSION Decreased capillary density and morphologic abnormalities indicated that hypoperfusion was more likely to be observed in supra-aortic SIEs patients. Combined NVC indicators could be instrumental for early identification of supra-aortic SIEs. Key Points • Minor morphological abnormalities and hemorrhages were only observed in supra-aortic SIEs patients. • Capillaroscopic density and minor morphological abnormalities or combined with at least two of the three items in the matrix model showed the probability occurrence of supra-aortic SIEs was 61.2-87.6%.
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Affiliation(s)
- Li Wang
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Huiyong Chen
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Zhenqi Ding
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Lingying Ma
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China
| | - Ying Sun
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
- Evidence-based Medicine Center, Zhongshan Hospital Fudan University, Shanghai, China.
| | - Lindi Jiang
- Department of Rheumatology, Zhongshan Hospital Fudan University, Shanghai, 200032, China.
- Evidence-based Medicine Center, Zhongshan Hospital Fudan University, Shanghai, China.
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Sundaray S, Mishra S, Dash SC, Sundaray NK. Nailfold Videocapillaroscopy in Connective Tissue Diseases with Raynaud's Phenomenon in an Indian Population. Rambam Maimonides Med J 2022; 13:RMMJ.10460. [PMID: 35089122 PMCID: PMC8798589 DOI: 10.5041/rmmj.10460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Microvasculopathy is characterized by progressive structural and functional damage to the microvessels and plays a key role in the pathogenesis of various connective tissue diseases (CTD). Nailfold videocapillaroscopy is an optimal and validated method for analysis of microvascular abnormalities and is able to differentiate secondary Raynaud's phenomenon (RP) of CTD from primary RP and healthy subjects. AIM To assess and analyze nailfold capillaroscopic findings in Indian subjects with secondary Raynaud and to compare with findings in healthy subjects. METHODS A total of 62 study participants including cases and controls underwent nailfold videocapillaroscopy. Capillary loop length, capillary width, capillary density, presence/absence of tortuosity, giant loops, neoangiogenesis, microhemorrhages, and avascular areas were the parameters studied. RESULTS All the quantitative and qualitative parameters studied were significantly associated with secondary RP. Mean loop length in cases of connective tissue diseases was significantly less than in the controls (225.74 μm versus 282.97 μm) (P=0.002). Capillary density was also reduced significantly in the cases as compared to the controls (4.6 versus 7.39/mm) (P<0.01), whereas it was markedly decreased in systemic sclerosis (SSc) and mixed connective tissue diseases (MCTD), and near normal in systemic lupus erythematosus (SLE). Tortuosity was the most frequent (77.4%) qualitative parameter. Scleroderma pattern was found in 62.5% of patients with SSc and in 60% with MCTD. Non-specific pattern was found in 80% of SLE cases and 50% of dermatomyositis cases. CONCLUSION Both quantitative and qualitative capillaroscopic changes are significantly associated with secondary RP. Scleroderma pattern was predominant in SSc and MCTD, whereas non-specific pattern was predominantly found in SLE and dermatomyositis.
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Affiliation(s)
- Sambit Sundaray
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhartha Mishra
- Department of Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Subhash Chandra Dash
- Department of Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
- To whom correspondence should be addressed. E-mail:
| | - Naba Kishore Sundaray
- Department of Medicine, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
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Pimenta da Fonseca E, Lins CF, de Sá Ribeiro DL, Santos WGD, Rosa G, Machicado V, Pedreira AL, Souza APMD, Baleeiro C, Dos Santos Ferreira LG, de Oliveira IS, da Silva JPCG, Atta AM, Santiago MB. Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy. J Clin Rheumatol 2021; 27:S198-S203. [PMID: 33337816 DOI: 10.1097/rhu.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without. METHODS Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test. RESULTS In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which "nonspecific changes" were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05). CONCLUSIONS The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ajax Merces Atta
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia
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Monfort JB, Chasset F, Barbaud A, Frances C, Senet P. Nailfold capillaroscopy findings in cutaneous lupus erythematosus patients with or without digital lesions and comparison with dermatomyositis patients: A prospective study. Lupus 2021; 30:1207-1213. [PMID: 33853419 DOI: 10.1177/09612033211010329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Differential diagnosis between cutaneous lupus erythematosus (CLE) and dermatomyositis (DM) may be challenging if digital lesions occur. OBJECTIVES To compare nailfold capillaroscopy (NFC) findings in CLE patients with or without digital involvement, and to compare capillaroscopic findings between CLE patients with digital lesions and DM patients. METHODS Prospective monocentric study including CLE and DM patients. NFC was performed and standardized items were recorded. RESULTS Fifty-one CLE patients and 10 DM patients with digital lesions were included. A scleroderma pattern was found in 6 patients (12%): in 5 out of 17 patients with digital lesions, compared with only 1 out of 34 patients without digital lesions (p = 0.01). In multivariate analysis, CLE digital lesions and digital ulcerations were statistically associated with scleroderma pattern. CLE digital lesions were significantly associated with architectural disorganization (p = 0.0003) and capillary rarefaction (p = 0.0038). A scleroderma pattern was significantly more frequent in DM patients (80%) than in CLE patients with digital lesions (30%, p = 0.018). Capillaroscopic findings were not significantly different between CLE patients with digital lesions and DM patients. CONCLUSION Although scleroderma pattern is more frequent in DM patients than in CLE patients with digital lesions, NFC cannot formally distinguish CLE from DM.
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Affiliation(s)
- Jean-Benoît Monfort
- Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, F-75020 Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, F-75020 Paris, France
| | - Annick Barbaud
- Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, F-75020 Paris, France
| | - Camille Frances
- Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, F-75020 Paris, France
| | - Patricia Senet
- Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, F-75020 Paris, France
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Zarudna OI, Venher IK, Dovbush AV. CONNECTIVE TISSUE DISEASES: FOCUS ON MICROCIRCULATORY BED. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2020. [DOI: 10.11603/ijmmr.2413-6077.2019.2.10671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. A microcirculatory bloodstream is a target, source and reason of the pathological process in patients with systemic connective tissue diseases.
Objectives. This study is focused on meta-analyses of biopsy material of skin flaps harvested from patients’ fingers to identify specific morphological changes.
Methods. A retrospective analysis of the medical records of 39 examinees with systemic sclerosis (SSc), 45 with Systemic Lupus Erythematosus (SLE), and 45 with rheumatoid arthritis (RA) was performed. The condition of peripheral hemodynamics was examined with longitudinal rheovasography of arms and legs. Endothelin-1 (ЕТ1) concentration was evaluated by immunoenzymatic method. We assessed other results of clinical and laboratory tests to compare them with morphological changes of the microcirculatory bed.
Results. Most patients involved suffered from abnormal peripheral hemodynamics. It was revealed that kidneys, lungs or heart were damaged more frequently in the patients with peripheral blood circulation disorders, which were the most significant in the patients with SSc (p<0.05). Disorders of peripheral blood flow were exacerbated in case of lengthening of the disease course. Concentration of ЕТ1 was relevantly higher in the patients with peripheral blood flow disorders. Number of pathologic capillaries was the highest in the SSc patients.
Conclusions. In terms of integral estimation, extremely significant changes of microcirculatory bloodstream were evidenced in the patients with SSc. However, some morphometric peculiarities were revealed in the patients without peripheral blood flow disorders. Thus, normal rheovasography did not exclude any microcirculation disorders.
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Nailfold Capillaroscopy in Systemic Lupus Erythematosus (SLE): a Point-of-Care Tool That Parallels Disease Activity and Predicts Future Complications. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019. [DOI: 10.1007/s40674-019-00133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nailfold capillaroscopic changes in Egyptian patients with psoriatic arthritis in comparison to rheumatoid arthritis. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Fatemi A, Erlandsson BE, Emrani Z, Etehadtavakol M, Smiley A, Karbalaie A. Nailfold microvascular changes in patients with systemic lupus erythematosus and their associative factors. Microvasc Res 2019; 126:103910. [PMID: 31408627 DOI: 10.1016/j.mvr.2019.103910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/04/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine capillaroscopic changes in patients with systemic lupus erythematosus (SLE) and their predictors. METHODS Fifty-nine SLE patients and 31 controls were enrolled in a cross-sectional study. Nailfold capillaroscopy examinations were performed, and qualitative semi-quantitative and quantitative parameters were evaluated in all fingers. Demographic features and lupus characteristics, such as renal involvement, medications, laboratory data, disease activity (SLEDAI) and damage, were recorded. The predictors of capillaroscopic abnormalities were obtained by backward stepwise regression analysis. RESULTS Capillary numbers of right hands were significantly lower in patients than in controls [8.74 (1.66) vs. 9.63 (1.80), P = 0.0001]. Capillaries were wider in patients than in controls in right [56.32 μm (16.76) vs. 50.43 μm (10.16), P = 0.002] and left hands [54.40 (15.02) vs. 49.71 (9.77), P = 0.005]. Capillaries were shorter in SLE patients than in controls. Multivariate analysis revealed that the main associative factors of microvascular abnormalities were gender, drinking tea and hydroxychloroquine use for giant capillaries, SLEDAI and low C3 for avascularity and age, lupus nephritis and corticosteroid use for ramification. CONCLUSION Most nailfold capillaroscopic abnormalities were more common in SLE patients than in controls. Hydroxychloroquine, corticosteroids, SLEDAI, low complement and lupus nephritis may be the major prognostic factors for microvascular changes in SLE patients.
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Affiliation(s)
- Alimohammad Fatemi
- Rheumatology Section, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Björn-Erik Erlandsson
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Sweden.
| | - Zahra Emrani
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahnaz Etehadtavakol
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Abdolamir Karbalaie
- School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Sweden.
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Saygin D, Highland KB, Tonelli AR. Microvascular involvement in systemic sclerosis and systemic lupus erythematosus. Microcirculation 2019; 26:e12440. [PMID: 29323451 DOI: 10.1111/micc.12440] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
Abstract
Microvascular changes play central roles in the pathophysiology of SSc and SLE, and represent major causes of morbidity and mortality in these patients. Therefore, clinical tools that can assess the microvasculature are of great importance both at the time of diagnosis and follow-up of these cases. These tools include capillaroscopy, laser imaging techniques, infrared thermography, and iontophoresis. In this review, we examined the clinical manifestations and pathobiology of microvascular involvement in SSc and SLE as well as the methodologies used to evaluate the microvasculature.
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Affiliation(s)
- Didem Saygin
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristin B Highland
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Cutolo M, Melsens K, Wijnant S, Ingegnoli F, Thevissen K, De Keyser F, Decuman S, Müller-Ladner U, Piette Y, Riccieri V, Ughi N, Vandecasteele E, Vanhaecke A, Smith V. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev 2018; 17:344-352. [PMID: 29427827 DOI: 10.1016/j.autrev.2017.11.025] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 01/03/2023]
Abstract
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Via Balbi 5, Genoa, Italy.
| | - Karin Melsens
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Sara Wijnant
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy.
| | - Kristof Thevissen
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Benekestraße 2-8, 61231 Bad Nauheim, Germany.
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialities, Sapienza University, Piazzale Aldo Moro 5, Rome, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy
| | - Els Vandecasteele
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
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