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Increased capillary permeability in systemic rheumatoid vasculitis: detection by dynamic fluorescence nailfold
E Hachulla1, M Perez-Cousin, R M Flipo
1Department of Internal Medicine, Centre Hospitalier et Universitaire, Lille, France.
The Journal of Rheumatology
|July 1, 1994
Summary
Dynamic fluorescence nailfold capillaroscopy reveals functional capillary wall alterations in rheumatoid arthritis (RA) patients. This technique is valuable for suspecting systemic rheumatoid vasculitis (SRV) due to its high negative predictive value.
Area of Science:
- Rheumatology
- Dermatology
- Vascular Biology
Background:
- Rheumatoid arthritis (RA) is increasingly linked to vascular involvement.
- Histological studies suggest capillary abnormalities in RA patients.
Purpose of the Study:
- To evaluate morphological and functional changes in skin capillaries of RA patients.
- To assess the utility of nailfold fluorescence videomicroscopy for diagnosing systemic rheumatoid vasculitis (SRV).
Main Methods:
- Nailfold fluorescence videomicroscopy was employed to study capillary permeability.
- Patients included those with SRV, active RA without vasculitis, and healthy controls.
- Fluorescein sodium was used to assess transcapillary dye diffusion.
Main Results:
- Conventional capillaroscopy showed no differences between SRV and RA groups.
- Fluorescence videomicroscopy detected increased dye diffusion in 9/9 SRV patients, 13/22 RA patients, and 4/16 controls.
- Sensitivity for SRV was 100%, specificity 44%, PPV 34%, and NPV 100%.
Conclusions:
- Functional capillary wall alterations occur in RA patients, with or without vasculitis.
- Dynamic fluorescence nailfold capillaroscopy is useful for suspecting SRV in RA patients.
- The technique's high negative predictive value is particularly noteworthy.