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Association between nailfold capillaroscopy abnormalities and autoimmune disease in pediatric populations
Andraia R Li1, Connor D Burke1, Colby S Purvis1
1Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
Insights
Nailfold capillaroscopy (NFC) reveals significant nailfold capillary abnormalities in children with autoimmune diseases. This method may aid in early detection of rheumatic conditions, potentially shortening diagnostic timelines.
Area of Science:
- Pediatric Rheumatology
- Dermatology
- Autoimmune Diseases
Background:
- Delayed diagnosis of autoimmune diseases in children can lead to long-term complications.
- Nailfold capillaroscopy (NFC) is a non-invasive technique that visualizes capillaries, potentially identifying early disease markers.
Purpose of the Study:
- To evaluate the association between nailfold capillary abnormalities and the presence of autoimmune disease in pediatric patients.
- To determine if NFC can serve as an early diagnostic tool for autoimmune conditions in children.
Main Methods:
- A systematic literature search was conducted across PubMed, EMBASE, and Scopus for studies published before March 17, 2021.
- Included were observational studies comparing NFC findings in children with autoimmune disease versus healthy controls (HC).
- A random-effects meta-analysis was used to pool odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Nine studies involving 641 participants (398 patients, 243 controls) were analyzed.
- Children with autoimmune disease were nearly 10 times more likely to exhibit abnormal nailfold capillaries compared to HC (OR 9.88).
- Dilated capillaries were the most frequent abnormality (OR 27.90), followed by reduced capillary density, giant capillaries, hemorrhages, and avascularity.
Conclusions:
- Pediatric patients with autoimmune disease demonstrate a significantly higher prevalence of nailfold capillary abnormalities.
- Nailfold capillaroscopy shows promise as a valuable tool for the early identification of rheumatic diseases in children.
- Implementing NFC could potentially reduce the diagnostic delay for autoimmune conditions in pediatric populations.
Objective:
Time to diagnosis of autoimmune disease in pediatric populations can take years but nailfold capillaroscopy (NFC) may identify early signs of autoimmune disease. The aim of this study is to assess the association between nailfold capillary abnormalities and autoimmune disease in children.
Methods:
A systematic search of PubMed, EMBASE, and Scopus was performed to identify all studies published before March 17, 2021. Observational studies reporting NFC outcomes in children with autoimmune disease and healthy controls (HC) were eligible for inclusion. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effects meta-analytical model.
Results:
Nine of 3665 studies reporting on 641 patients (398 subjects, 243 controls) were included. Pediatric patients with autoimmune disease were 9.88 (95% CI 3.16-30.87, I2 = 80.1%) times more likely to have abnormal nailfold capillaries than HC. Of the capillaroscopic features, dilated capillaries (OR 27.90, 95% CI 2.17-349.05, I2 = 59.9%) were the most likely abnormality observed on NFC. This was followed by the likelihood of reduced capillary density (<7 capillaries/mm) (OR 19.91, 95% CI 3.79-105.52, I2 = 0%), giant capillaries (OR 12.87, 95% CI 2.38-69.45, I2 = 0%), hemorrhages (OR 13.89, 95% CI 5.34-36.16, I2 = 0%), and avascularity (OR 10.38, 95% CI 2.20-49.04, I2 = 0%).
Conclusions:
Children with autoimmune disease are significantly more likely to have nailfold capillary abnormalities. NFC may be useful in identifying early signs of underlying rheumatic disease and potentially decrease the time to diagnosis for this patient population.
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