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Nailfold videocapillaroscopy findings and associations with organ involvement in mixed connective tissue disease
Camille Kasser1, Gonçalo Boleto2, Yannick Allanore3
1Service de Rhumatologie, Hôpital Cochin, AP-HP Centre Université Paris Cité, Paris, France.
Objectives:
To investigate nailfold videocapillaroscopy (NVC) abnormalities in mixed connective tissue disease (MCTD).
Methods:
Patients with MCTD followed at the Rheumatology Department in Cochin Hospital (Paris, France) were identified based on individual record review. Diagnosis of MCTD required fulfillment of one of the three sets of classification criteria. Clinical and laboratory data were collected and NVC was performed on 4 fingers of both hands by one assessor. NVC patterns were analysed by two independent observers.
Results:
We identified 51 MCTD patients [mean age 51±12 years, 86% female, 31% had interstitial lung disease (ILD)]. NVC images were available for 40 patients. Three different NVC patterns were identified: 'normal' (15 %); 'non-specific microangiopathy' (40%) and 'scleroderma pattern' (45%). 'Scleroderma pattern' was associated with skin sclerosis (9/18 vs. 5/32; p=0.008) and digital ulcers (6/18 vs. 2/32; p=0.017). We observed a reduction in the number of capillaries in patients with ILD (4.80±1.87 vs. 6.03±1.47; p=0.039). Patients with severe reduction of capillary density (≤4/mm) were more likely to have ILD (5/7 vs. 5/33; p=0.002). Neoangiogenesis was more frequent in patients with ILD (6/13 vs. 4/27; p=0.034). The association between severe reduction of capillary density and ILD was observed independently of the presence of the 'scleroderma pattern' and skin sclerosis.
Conclusions:
We identified three NVC patterns in MCTD patients. 'Scleroderma pattern' was associated with presence of skin sclerosis and digital ulcers. Severe capillary loss was significantly associated with the presence of ILD. Our results indicates that NVC may be helpful for disease risk stratification in MCTD.
Insights
Nailfold videocapillaroscopy (NVC) revealed three patterns in mixed connective tissue disease (MCTD). The scleroderma pattern correlated with skin sclerosis and digital ulcers, while severe capillary loss indicated interstitial lung disease (ILD).
Area of Science:
- Rheumatology
- Vascular Biology
- Connective Tissue Diseases
Background:
- Mixed connective tissue disease (MCTD) is an autoimmune disorder with overlapping features of systemic lupus erythematosus, systemic sclerosis, and polymyositis.
- Nailfold videocapillaroscopy (NVC) is a non-invasive technique to assess microvascular abnormalities.
Purpose of the Study:
- To investigate the spectrum of nailfold videocapillaroscopy (NVC) abnormalities in patients diagnosed with mixed connective tissue disease (MCTD).
- To determine the association between specific NVC patterns and clinical manifestations, including interstitial lung disease (ILD) and skin sclerosis.
Main Methods:
- Retrospective review of 51 patients diagnosed with MCTD based on established classification criteria.
- Collection of clinical and laboratory data, including assessment of skin sclerosis and digital ulcers.
- Performance and analysis of nailfold videocapillaroscopy (NVC) on 4 fingers of both hands by independent observers.
Main Results:
- Three distinct NVC patterns were identified: normal (15%), non-specific microangiopathy (40%), and scleroderma pattern (45%).
- The scleroderma pattern was significantly associated with the presence of skin sclerosis (p=0.008) and digital ulcers (p=0.017).
- Severe capillary loss (≤4/mm) and increased neoangiogenesis were more frequent in patients with interstitial lung disease (ILD) (p=0.002 and p=0.034, respectively).
Conclusions:
- Nailfold videocapillaroscopy (NVC) reveals characteristic patterns in mixed connective tissue disease (MCTD).
- The scleroderma pattern on NVC is linked to skin sclerosis and digital ulcers.
- Severe capillary loss identified via NVC is a significant indicator of interstitial lung disease (ILD) in MCTD patients, aiding in disease risk stratification.
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