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Published on: August 7, 2017
Capillaroscopic observations in childhood rheumatic diseases and healthy controls
F Ingegnoli1, S Zeni, V Gerloni
1Department of Rheumatology, Istituto Gaetano Pini, University of Milan, Italy. francesca.ingegnoli@unimi.it
Insights
Video nailfold capillaroscopy (NFC) effectively identifies microvascular abnormalities in pediatric rheumatic diseases. This non-invasive method aids in early diagnosis and monitoring of conditions like juvenile idiopathic arthritis and scleroderma spectrum disorders.
Area of Science:
- Pediatric Rheumatology
- Vascular Biology
- Non-invasive Diagnostics
Background:
- Microvascular abnormalities are common in childhood rheumatic diseases.
- Nailfold capillaroscopy (NFC) offers a potential method for their assessment.
- Understanding these changes is crucial for diagnosis and management.
Purpose of the Study:
- To characterize microvascular changes in children with rheumatic diseases using NFC.
- To assess the evolution of these capillary changes over time.
- To compare findings in patients with healthy controls.
Main Methods:
- Video nailfold capillaroscopy (NFC) performed on 118 children with various rheumatic diseases (JIA, MCTD, PRP, SLE, JSSc, JDM) and 70 healthy controls.
- Patients with significant abnormalities or scleroderma pattern were followed for at least 12 months.
- Analysis of capillary number, size, shape, and arrangement.
Main Results:
- Juvenile idiopathic arthritis patients showed normal capillary morphology compared to controls.
- Mixed connective tissue disease, systemic lupus erythematosus, and juvenile dermatomyositis patients exhibited significantly more major capillary abnormalities.
- 5/8 juvenile systemic sclerosis patients presented with a scleroderma pattern at baseline; follow-up revealed non-unidirectional changes in connective tissue diseases.
Conclusions:
- Nailfold capillaroscopy (NFC) is a simple, non-invasive tool for evaluating microvascular abnormalities in pediatric rheumatic conditions.
- NFC can aid in the early detection and monitoring of scleroderma spectrum disorders.
- The method provides valuable insights into microvascular changes in childhood rheumatic diseases.
Objective:
To describe, by using video nailfold capillaroscopy (NFC), microvascular abnormalities in children with rheumatic diseases and to evaluate the capillary changes over a follow up period.
Methods:
118 children suffering from rheumatic diseases: 55 juvenile idiopathic arthritis (JIA), 7 mixed connective tissue disease (MCTD), 6 primary Raynaud's phenomenon (PRP), 34 systemic lupus erythematosus (SLE), 8 juvenile systemic sclerosis (JSSc) and 8 juvenile dermatomyositis (JDM) were included in the study. Patients with major capillaries abnormalities or scleroderma pattern were followed up for at least 12 months. 70 age- and sex-matched healthy controls (HC) were also examined.
Results:
In HC there was a significant correlation between age and capillary length (p = 0.001). JIA patients showed capillary number, size, shape and arrangement similar to HC. Minor abnormalities were frequently observed. The percentage of major abnormalities were significantly increased compared to HC in MCTD (p = 0.008), SLE (p = 0.0002) and JDM patients (p < 0.0001). 5/8 of JSSc had a scleroderma pattern from the onset of the disease. The serial observations in connective tissue diseases also showed that the evolution of capillaroscopic pattern was not unidirectional. In fact, in some nailfolds there was an increase in capillary loss and in avascular areas, whereas sometimes it remained stable on repeated examination.
Conclusion:
NFC can be used as a simple, inexpensive, non-invasive method to evaluate the microvascular abnormalities in childhood rheumatic conditions, and it may be useful in early recognition and monitoring scleroderma spectrum disorders.