AB0758 Evaluation of nailfold video capillaroscopy in 296 patients with connective tissue diseases
Authors: G. Kumánovics, G. Nagy, L. Czirják
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> The influence of the presence of Raynaud's phenomenon (RP) on microangiopathy is not well characterised in connective tissue diseases (CTDs). <h3>Objectives</h3> To characterise capillary density and capillary morphology by nailfold video capillaroscopy (NVC) in different CTDs with a special focus on the presence/absence of Raynaud's phenomenon (RP) and overlap syndromes. <h3>Methods</h3> 296 patients with systemic sclerosis (SSc), systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies (IIM), Sjogren's syndrome (SS), antiphospholipid syndrome (APS), rheumatoid arthritis (RA), systemic vasculitis and undifferentiated connective tissue disease (UCTD) were investigated by NVC. Control groups consisted of 25 healthy controls (HC) and 22 primary RP (PRP) cases. <h3>Results</h3> The mean capillary density was significantly decreased in SSc, SLE, SS, IIM and APS either compared to HC or PRP cases. Mean microangiopathy evolution score (MES) was higher in SSc, SLE, SS, IIM and APS compared to both HC and PRP cases. SSc, SLE, SS patients had a significantly higher giant capillary number compared to either HC or primary RP control cases. Average haemorrhage score was significantly higher in SSc and SS but not in SLE, RA, IIM and APS compared to HC. Average dilatation point was higher in all investigated CTDs compared to HC. Except RA, all investigated CTDs showed significantly higher capillary loss score compared to either PRP controls or HC. RA cases showed such a difference only compared to HC. Average disorganisation score was significantly higher in all CTDs compared to HC but not compared to PRP cases. Ramification score was significantly elevated in SSc and IIM compared to PRP and HC, but no difference was observed in SLE, SS, APS and RA. The mean capillary density was decreased, and MES was higher in RP associated cases compared to patients without RP in cases with SLE, IIM, and RA. Conversely, the presence of RP did not influence these particular parameters in cases with APS and SS. Except SSc, the impact of overlap features was not remarkable on major capillaroscopic findings. SSc capillary pattern was present in 75.3% of all SSc cases, most commonly SSc late pattern was observed (58.43%). SSc pattern was present in other CTD cases too (15.4%–40.7%). SSc patients with a DLCO&lt;70% had significantly more giant capillaries, avascularity, late SSc pattern, increased MES, and lower capillary density compared to cases with DLCO&gt;70%, but in the other CTDs decreased DLCO was not associated with similar pronounced capillary damage. <h3>Conclusions</h3> Microangiopathy with decreased capillary density and increased MES were present in all CTDs compared to controls. RP caused most pronounced impairment in SLE, IIM and RA compared to non-RP patients, but had no major effect on SS, and APS. Except SSc, the presence of overlap syndrome did not show a remarkable influence on the microvascular abnormalities compared to pure idiopathic cases. SSc late pattern was most frequently observed in CTDs other than SSc, and it may appear even in patients without RP. Previous associations shown by other authors of decreased DLCO and capillary damage in SSc was confirmed. Capillaroscopy is useful not only in IIM and SSc patients but also in all SLE cases and RP associated SS and RA patients. Capillary density and MES are the most valuable parameters. <h3>Disclosure of Interest</h3> None declared