AB0592 EVALUATION OF MICROCIRCULATION IN NAIFOLD CAPILLAROSCOPY IN PATIENTS WITH RHEUMATOID ARTHRITIS, CONSIDERING THE INFLUENCE OF CARDIOVASCULAR DISEASES
Authors: A. Kęsiak, P. Żuchowski, S. Jeka, V. Opoka- Winiarska
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by symmetrical polyarthritis. The chronic inflammatory process is responsible for the premature development of atherosclerotic changes. It is estimated that RA significantly increases the risk of cardiovascular diseases, regardless of traditional risk factors. Nailfold capillaroscopy is a non-invasive, real-time assessment of the microcirculation, commonly used in the diagnosis and monitoring of patients with scleroderma spectrum diseases. Recently its application in evaluating RA patients has been considered. <h3>Objectives:</h3> The aim of the study was to evaluate microcirculation using nailfold capillaroscopy in RA patients compared to healthy individuals from the general population. Additional aim was to compare the differences in the capillaroscopy findings between RA patients with coexisting cardiovascular disease (CVD+) and RA patients without cardiovascular disease (CVD-). <h3>Methods:</h3> The study included 60 (48F/12M) RA patients, the mean age and duration of the disease were: 52.6 ± 11 years and 11.3 ± 8.3 years, respectively. In the study group, 30 individuals (23F/7M) were RA CVD+ patients, while 30 individuals (25F/5M) have no cardiovascular diseases (RA CVD-). The control group consisted of 30 (22F/8M) healthy individuals from the general population, with a mean age of 50.6 ± 8.4 years. All subjects underwent capillaroscopic examination- acquired images were assessed qualitatively, semi-quantitatively, and quantitatively. <h3>Results:</h3> No significant difference was observed in the quantitative assessment of the mean number of capillaries per 1 mm between the RA group and the control group, with values of 8.5 ± 1.2 and 8.8 ± 0.9, respectively (p=0.163). Using the semi-quantitative method, however, a higher score for capillary density was obtained in the RA group compared to the control group (p=0.023). The difference between the quantitative and semi-quantitative assessment indicates a disorganization in the arrangement of capillaries which was confirmed by the score for disorganization of capillary distribution – RA patients 0.19 ± 0.23, control group 0.05 ± 0.7 (p=0.004). RA patients had a higher average capillary width at the apex of the loop compared to the control group: RA CVD+ 17.1± 3.0 µm (p= 0.032), RA CVD- 16.2± 3.1 µm (p= 0.03), control group 15.6±2.1 µm. Using the semi-quantitative method (score) for the percentage of dilated capillaries, significantly higher values were found in the RA CVD+ group compared to the control group, with mean score values of 0.35 ± 0.31 and 0.21 ± 0.19, respectively (p=0.049). The mean score value for the number of abnormal capillaries in RA group was significantly higher compared to the control group, with values of 0.53 ± 0.46 and 0.22 ± 0.17, respectively (p&lt;0.001). Regarding the visibility of the subpapillary plexus, significant differences were found between both the study group and the control group (p=0.001) and between the subgroups of RA patients with CVD+ and CVD- (p=0.027). When assessing the severity of microangiopathy defined as the sum of scores for the number of capillaries per 1mm, presence of abnormal capillaries and disorganization of capillaries arrangement, statistically higher values were observed in RA patients compared to the control group (p&lt;0.001). Even when dividing the population of RA patients into CVD+ and CVD- subgroups and comparing them with the control group, significant differences were still noticeable; however, no significant difference was found between the RA CVD+ and CVD- subgroups. <h3>Conclusion:</h3> In the course of RA, the disturbances in microcirculation can be observed in the nailfold capillaroscopy. Reduced density of vascular loops, increased number of abnormal capillaries, disorganization of capillary arrangement, increased visibility of the subpapillary plexus indicate microangiopathy. Widening of the capillary loops and increased visibility of the subpapillary plexus are characteristic of RA patients with cardiovascular diseases and may be considered as potential markers of this complication. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>