Nailfold capillaroscopy as diagnostic test in patients with psoriasis and psoriatic arthritis: A systematic review

Investigation of Microvascular Involvement Through Nailfold Capillaroscopic Examination in Children with Familial Mediterranean Fever

Background and Objectives: Familial Mediterranean fever (FMF) is a lifelong autoinflammatory disease characterized by episodes of fever and aseptic polyserositis. Commonly associated with vasculitis, FMF's impact on microcirculation was investigated by examining nailfold capillaries using capillaroscopy. Materials and Methods: This study included 32 female and 28 male FMF patients diagnosed according to the Tel Hashomer and Yalçınkaya criteria and a control group of 20 female and 10 male age-matched cases. Demographic characteristics, medical history (abdominal pain, fever, chest pain, and joint pain), and physical examination findings of the cases were assessed. FMF gene mutations, acute-phase reactants, urine analysis, and spot urine protein/creatinine ratios were evaluated. Nailfold capillaries were examined via capillaroscopy by the same dermatology specialist. Results: There was no significant age or gender difference between groups. The most common symptoms in the case group were abdominal pain (81.7%) and joint pain (65%). Pathological findings in capillaroscopy, such as microhemorrhages and avascular areas, were significantly more frequent in the FMF case group (p < 0.001; p < 0.001). Physiological findings, including hairpin-shaped capillaries and shortened loops, were significantly more common in the control group (p = 0.001; p = 0.034). No significant relationships were found between kidney involvement, subclinical inflammation, presence of microhemorrhages and avascular areas in capillaroscopy, and disease duration. Additionally, no significant differences were observed in capillaroscopic findings between those with exon-10 mutations in the MEFV gene and those with non-exon-10 mutations. Conclusions: In conclusion, our study demonstrated secondary microvascular findings due to inflammation in FMF patients using capillaroscopy, a cost-effective and safe tool.

Combined semiquantitative nail-enthesis complex ultrasonography and capillaroscopy in psoriasis and psoriatic arthritis

This pilot study investigates distinctive features within the nail-enthesis complex among Psoriatic arthritis (PsA), Psoriasis (PSO), Rheumatoid Arthrit is (RA), and Healthy Control (HC) groups, utilizing a combined approach of ultrasound (US) and nailfold videocapillaroscopy (NVC). Clinical assessments and comprehensive US and NVC evaluations of the nail-enthesis complex were conducted on 72 subjects (18 PsA, 16 PSO, 19 RA, 19 HC). Unsupervised clustering models and factor analysis were employed to identify patterns and interrelationships between US and NVC parameters. Significant structural differences were detected, emphasizing the discriminatory power of semiquantitative US scores (GS BUNES, Wortsman type). Trends in vascularization aligned with literature, showcasing dysregulated angiogenesis in PsA and PSO. The clustering model effectively distinguished HC from PsA subjects, revealing a potential continuum between PSO and PsA. RA subjects exhibited subsets with features akin to both HC and PsA/PSO, underscoring the complexity of its manifestations. This study provides insights into nail-enthesis complex alterations, highlighting distinctions among PsA, PSO, RA, and HC subjects. The clustering model emphasizes potential overlap between PSO and PsA. Factor analysis elucidates collinearity in US-detected characteristics, while suggesting limited discriminative power of some quantitative parameters. These findings advocate for further exploration in prospective trials, potentially predicting the evolution of undifferentiated early arthritis and arthritis onset in PSO patients.

Nailfold capillaroscopy for diagnosis of onychodystrophies: A prospective cross-sectional study

BACKGROUND

Nail diseases are often associated with significant physical and psychosocial burden, but diagnosis is challenging due to nonspecific clinical and histological findings. Nailfold capillaroscopy has been studied for the diagnosis of systemic diseases, but studies on nail diseases are lacking.

OBJECTIVE

The objectives of our study were to characterize and compare capillary changes in a set of nail conditions versus controls, between nail groups, and based on demographic/clinical criteria.

METHODS

This was a prospective cross-sectional study of patients with nail psoriasis, onychomycosis, idiopathic onycholysis, brittle nail syndrome, nail lichen planus, retronychia, other nail conditions, and no nail findings (controls) undergoing capillaroscopy imaging/analysis.

RESULTS

Nail psoriasis versus control patients demonstrated decreased capillary length/density and increased abnormal capillaries, with higher frequency in older, male patients. Onychomycosis was associated with increased meandering capillaries compared with controls, nail psoriasis, and nail lichen planus. Retronychia is associated with increased disorganized polymorphic capillaries compared with controls and onychomycosis.

LIMITATIONS

Limitations include a small sample size for certain nail conditions and small numbers of nail psoriasis patients with psoriatic arthritis.

CONCLUSION

Our findings highlight nailfold capillaroscopy as a potentially quick, cost-effective, and noninvasive imaging modality, as an adjunct for diagnosis and treatment initiation for patients with onychodystrophies.

What Is New in Nail Psoriasis?

<b><i>Background:</i></b> Nail involvement is very frequent in psoriasis and may significantly affect patients’ quality of life due to clinical and functional impairment. In addition, nail psoriasis constitutes a negative prognostic factor for the development of psoriatic arthritis (PsA), even in the absence of cutaneous disease. <b><i>Summary:</i></b> Herein we provide an updated review on the diagnostic evaluation of nail psoriasis using clinical assessment and implementation of imaging techniques including dermoscopy, capillaroscopy, ultrasonography, and optical coherence tomography. In addition, we summarize consensus guidelines for the management of nail psoriasis and provide efficacy data on the use of intralesional, topical, and the most recently approved targeted systemic therapies. <b><i>Key Messages:</i></b> Physicians should be aware of the importance of prompt diagnosis and management of nail psoriasis, to improve patient outcomes and decrease the risk of PsA development.

Nailfold Capillaroscopy Findings in Patients With Psoriasis Vulgaris and Different Domains of Psoriatic Arthritis

Background

Psoriasis is a chronic autoimmune disease with longtime activity and multisystem affection. Nailfold capillaroscopy (NC) is a simple noninvasive microscopic tool useful for identification of nailfold microvasculopathy.

Objective

The present study aimed to compare NC findings in patients with psoriasis vulgaris (PsV) and psoriatic arthritis (PsA) with different clinical domains.

Methods

The present cross-sectional study included 200 psoriasis patients classified into five 40-patient groups: group I (GI) included PsA patients with predominant peripheral arthritis; group II (GII) included PsA patients with predominant peripheral arthritis and dactylitis and/or enthesitis; group III (GIII) included PsA patients with predominant axial affection; group IV (GIV) patients included PsA patients with predominant axial affection and dactylitis and/or enthesitis and group V (GV) included patients with PsV. In addition, there were 40 age and sex-matched healthy controls (GVI).

Results

The studied patients had capillary density of 6.7 ± 3.5/mm with 90 patients (45.0 %) having reduced capillary density. GI-GIV patients had significantly lower capillary density and higher frequency of patients with reduced capillary density as compared to GV patients. The reported capillary dimension in the studied patients is 15.7 ± 7.9 μm and 55 patients (27.5 %) had large/giant capillaries. Patients in GV had significantly lower capillary dimension in comparison to GI-GIV patients. There were 64 patients (32.0 %) with abnormal capillary morphology and 47 patients (23.5 %) with capillary hemorrhages.

Conclusions

PsA patients of all domains have lower capillary density and larger capillary dimensions as compared to PsV patients.

Nail psoriasis and nail lichen planus: Updates on diagnosis and management

BACKGROUND

Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance.

OBJECTIVE

We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus.

METHODS

An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus.

RESULTS

Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections.

CONCLUSIONS

We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.

Nailfold capillaroscopy reveals early peripheral microcirculation abnormalities in children affected by heterozygous familial hypercholesterolemia

BACKGROUND

nailfold capillaroscopy (NCF) is a non-invasive imaging technique to seek peripheral microcirculation abnormalities in children and adults. Familial hypercholesterolemia is a genetic disorder caused by mutations capable of increasing blood levels of low-density lipoproteins cholesterol (LDL-C), thus triggering early atherosclerosis. The study aims at evaluating peripheral microcirculation in children with heterozygous familial hypercholesterolemia (HeFH) by means of NFC in comparison with healthy peers and at searching for possible correlations between these abnormalities and patients' lipid panel.

METHODS

thirty-six HeFH patients were enrolled (13 males and 23 females. Mean age 8 ± 3 years; age range 3-13 years). They had increased levels of total cholesterol (237.9 ± 34.2 mg/dl) and LDL-C (154.2 ± 37.6 mg/dl). Both values were ≥95th gender and age specific centile. All the subjects in the study underwent NFC.

RESULTS

In 69.4 % of HeFH children nailfold capillaries were tortuous (p < 0.00001 compared to healthy controls). In 41.6 % the number of capillaries was markedly reduced (<7 capillaries/mm). The mean number of capillaries was 8.4 ± 2.6/mm in HeFH and 12.2 ± 1.4/mm in healthy controls (p < 0.00001). In 100 % of the sample size capillary blood flow was slowed down (p < 0.00001). In 50 % of the sample size a blood "sludge" phenomenon was seen (p < 0.00001). No gender differences were detected. Sludge phenomenon was seen only in those with LDL-C over 99th centile (p < 0.00001).

CONCLUSION

NCF allows the identification of an early peripheral microvascular dysfunction in HeFH children which is similar to that already seen in atherosclerotic disease. Prompt identification of these capillary abnormalities may be crucial in implementing early prevention measures.