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Capillaroscopy is a dynamic process in mixed connective tissue disease.

A de Holanda Mafaldo Diógenes¹, E Bonfá, R Fuller

¹Division of Rheumatology, University of São Paulo, Brazil.

|April 19, 2007

Summary

Nailfold capillaroscopy (NC) reveals dynamic scleroderma-pattern (SD-pattern) changes in mixed connective tissue disease (MCTD). Specific SD-pattern parameters indicate lung involvement and disease severity in MCTD patients.

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Area of Science:

Rheumatology
Dermatology
Internal Medicine

Background:

Mixed connective tissue disease (MCTD) is an autoimmune disorder with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis.
Nailfold capillaroscopy (NC) is a non-invasive technique used to assess microvascular changes in connective tissue diseases.
The 'scleroderma-pattern' (SD-pattern) observed in NC is a characteristic finding in systemic sclerosis and may also be relevant in other connective tissue diseases.

Purpose of the Study:

To evaluate the clinical relevance and dynamic changes of the SD-pattern in patients with MCTD.
To determine if specific NC findings correlate with organ involvement and disease severity in MCTD.
To assess the utility of NC as a prognostic tool in MCTD management.

Main Methods:

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A cohort of 63 patients diagnosed with MCTD according to Kasukawa's criteria were retrospectively analyzed.
Patients with available previous NC findings (at least five years prior) were included.
Organ involvement, autoantibody profiles, and HRCT for interstitial lung disease were assessed at entry. SD-pattern parameters, including avascular areas (AA) and capillary density, were analyzed over time.

Main Results:

The prevalence of SD-pattern in MCTD patients was high, observed in 65% at entry and 71.5% previously, with no significant change over time (P = 0.20).
A significant decrease in moderate/severe avascular areas (AA) was noted at entry compared to previous NC (26.5% vs. 53%, P = 0.013).
Avascular areas (AA) were significantly associated with interstitial lung disease (76% of patients with ILD had AA, P = 0.017). Reduced capillary density was more frequent in patients on immunosuppressive therapy (66.7%, P = 0.001).

Conclusions:

NC in MCTD is a dynamic process, with the SD-pattern showing variability over time.
Specific SD-pattern parameters, particularly avascular areas (AA), are valuable indicators of lung involvement and disease severity in MCTD.
NC findings, when analyzed dynamically and in conjunction with specific parameters, can aid in assessing disease activity and prognosis in MCTD.