Background Capillaroscopy is a noninvasive method for evaluating nailfold abnormalities and differentiating between primary and secondary Raynaud syndrome (RP). It is widely investigated in systemic sclerosis (SSc) but not in systemic lupus erythematosus (SLE). SSc pattern is described with decreased capillary density, haemorrhage, neoangiogenesis and avascularity.
Objective Evaluate capillaroscopic pattern and clinical features in SLE patients; examine the influence of RP on capillaroscopic pattern and capillary density.
Methods 318 systemic autoimmune patients and 25 healthy controls were collected, 73 fulfilled SLE classification criteria. All patients underwent detailed nailfold capillaroscopic investigation. Density, intercapillary distance was recorded as well as the progression and diagnostic parameters described by Cutulo in semiquantitative manner. Presence of RP was investigated by a detailed questionnaire. Patients with and without RP were compared. 89 patients fulfilled SSc classification criteria, the median capillary density was 6.66 (5.2; 7.94) in this group, the median microangiopathia evaluation score (MES) was 1.97 (1.19; 3.13) in SSc subgroup.
Results 23 patients had pure ‘idiopathic’ SLE, 36 fulfilled SLE plus another classification criteria, 11 SLE plus two other, 2 SLE plus three other and 1 SLE plus four other. Median capillary density was 8.23 (7.4; 8.94), the median MES was 1.00 (0.56; 1.47); the median giant capillary number was 0.00 (0.00; 0.75) in the entire SLE group. 6.9% of all SLE patients had SSc early pattern, 1.4% SSc active pattern, 20.6% had SSc late pattern and 71.2% had no SSc pattern. Among patients having SSc pattern all except two had RP. Comparison of capillaroscopy of SLE patients with and without RP showed that patients in the former group had significantly lower capillary density (7.97 [7.19; 8.72] vs. 8.92 (8.19; 9.34), p<0.05). Dilatation point and giant capillary point was significantly higher in the RP-SLE subgroup (0.36 [0.13; 0.69] vs 0.13 [0.06; 0.28] p<0.05, 0.06 [0.00;0.28 vs. 0.00 [0.00; 0.00] p<0.001).
Conclusion SSc capillary pattern is present in SLE as well, most of these particular patients had Raynaud’s phenomenon. Patients having both SLE and RP have lower capillary density and worse capillary structure. SLE patients capillary density is higher than the density found in SSc controls.
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