73 research outputs found

    Capillaroscopy in 2016 : new perspectives in systemic sclerosis

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    Systemic sclerosis (SSc) is an autoimmune disorder of unknown etiology characterized by early impairment of the microvascular system. Nailfold microangiopathy and decreased peripheral blood perfusion are typical clinical aspects of SSc. The best method to evaluate vascular injury is nailfold videocapillaroscopy, which detects peripheral capillary morphology, and classifies and scores the abnormalities into different patterns of microangiopathy. Microangiopathy appears to be the best evaluable predictor of the disease development and has been observed to precede the other symptoms by many years. Peripheral blood perfusion is also impaired in SSc, and there are different methods to assess it: laser Doppler and laser speckle techniques, thermography and other emerging techniques

    The Impact of Nailfold Capillaroscopy in the Approach of Microcirculation

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    Nailfold capillaroscopy (NFC) is a simple, validated, and noninvasive method to assess the microcirculation, through direct visualization of the capillaries. Main patterns are classified, according to Cutolo et al., as scleroderma, further divided into early, active, or late patterns, or nonscleroderma. NFC findings include dilated loops, tortuosities, meandering or bushy capillaries, hemorrhage, or architectural distortion. NFC use has been indicated for the evaluation of Raynaud’s phenomenon (RP), once it permits the distinction between primary and secondary RP. NFC results accounts for diagnostic criteria of systemic sclerosis, but they can also be useful in staging other connective tissue autoimmune diseases, like systemic lupus erythematosus, inflammatory myositis, or vasculitis. The CSURI index uses NFC for prediction of digital ulcer relapse. Recent evidence revealed NFC can also be applied in systemic disorders with vascular involvement

    A Practical Overview of the Role of Capillaroscopy in Rheumatic Diseases

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    Nailfold capillaroscopy is currently the best method to investigate microvascular abnormalities in systemic sclerosis and related conditions, and in other rheumatic conditions in which there is a clinical suspicion of microangiopathy. Although easy to perform, it is essential that the operators have been properly trained about correct method of images acquisition and interpretation. There are some parameters to indicate a normal/healthy capillaroscopic picture, but it is important to consider that there is a great variability in the capillary structure both interindividual and intraindividual. The early differential diagnosis between primary and secondary RP is the best advantage that the technique may offer.Remarkable capillaroscopic alterations are found in the majority of cases of systemic sclerosis and the so-called “scleroderma spectrum disorders†(dermatomyositis, mixed connective tissue disease, undifferentiated connective tissue disease). Nevertheless, some capillaroscopic changes have been observed in systemic lupus erythematosus, Sjogren’s syndrome, psoriatic and rheumatoid arthritis.Discussion about controversies on this topic should be encouraged, leading to a progressive development of capillaroscopy as a routine investigation in rheumatology

    NVC in non-rheumatic disease

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    Nailfold video-capillaroscopy (NVC) is a useful diagnostic tool, used to early detect abnormalities in micro-circulation, providing a qualitative description of microvascular anomalies in Raynaud’s phenomenon. NVC role in the diagnosis of Systemic Sclerosis is well known. In other rheumatic conditions such as connective tissue diseases, vasculitis, and arthritis, the NVC anomalies are often included in a scleroderma like pattern. The use of NVC in non-rheumatic diseases (NRD), with remarkable microvascular damage, as diabetes, is not standardized yet, although several research studies are carrying on. The aim of this article is to provide a resume of published results in order to lay the groundwork for the employment of NVC both in the diagnosis and follow up of microvascular complication in NRD. Furthermore, we mention NVC findings in pathologies without well recognize microvascular damages in their pathogenesis : micro-vessels abnormalities may suggest a different point of view

    Handheld dermatoscopy as an easy-to-use capillaroscopic instrument in rheumatoid arthritis: A cross-sectional study

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    Background/aim: Nailfold video capillaroscopy is considered as a reliable method for evaluating peripheral microangiopathy in rheumatologic diseases. In this study, we aimed to demonstrate the utility of handheld dermatoscopy as an easy-to-use nailfold capillaroscopic instrument in patients with rheumatoid arthritis. Materials and methods: This cross-sectional study included patients with rheumatoid arthritis and healthy subjects. A handheld dermatoscopic examination of proximal nail fold was performed in each subject. The possible correlation of capillaroscopic findings with disease activity was evaluated using the disease activity score 28 (DAS28). Results: A total of 59 patients with rheumatoid arthritis and 60 healthy subjects were enrolled in the study. The presence of capillary enlargement, avascular areas, capillary deformities, and capillary vascular anomalies in the group of patients showed a statistically significant difference when compared with the healthy subjects. No correlation was found between the nail fold capillaroscopic findings and DAS28 score. Conclusion: Hand-held dermatoscopy seems to be a useful technique in the evaluation of nail fold capillary changes. We suggest that in patients with rheumatoid arthritis, when capillaroscopic examination is needed, it can be evaluated using handheld dermatoscopy. Selected patients who showed findings using this method can be further examined with classical capillaroscopy to obtain more quantitative data. © TÜBİTAK

    New Kids on the Block in SSc-PAH: May We Futurely Nail It Additionally Down to Capillaroscopy? A Systematic Literature Review

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    open7siObjective Pulmonary arterial hypertension (PAH) is one of the leading causes of death in systemic sclerosis (SSc). Current screening algorithms are hampered by low positive predictive values. Outcome measures that could futurely add to performance characteristics would be very welcome. Against this background, we aim to evaluate the role of nailfold videocapillaroscopy (NVC) using standardized definitions, in SSc related PAH (SSc-PAH). Methods A systematic review to identify original research papers documenting an association between NVC and right heart catheterisation defined SSc-PAH was performed according to the PRISMA guidelines. Subsequently, NVC parameters were subdivided into quantitative (capillary density, dimension, morphology, and haemorrhages), semi-quantitative and qualitative assessment (NVC pattern), according to the definitions of the EULAR Study Group on Microcirculation in Rheumatic Diseases. Results The systematic search identified 316 unique search results, of which 5 were included in the final qualitative analysis. The occurrence of incident SSc-PAH unequivocally associated in 2 longitudinal studies with progressive capillary loss (p=0.04 and p=0.033) and the progression to a severe (active/late) NVC pattern (p=0.05/0.01 and HR=5.12, 95%CI: 1.23- 21.27). In 3 cross-sectional studies, SSc-PAH was found to be unequivocally inversely associated with capillary density (p=0.001 and p<0.05) and associated with the presence of a severe NVC pattern (p=0.03 and p<0.05). Conclusion This is the first systematic literature review investigating the role of NVC in SSc-PAH using standardized description. Unequivocal associations were found between (incident) SSc-PAH and capillary density and NVC pattern. Integration of NVC into current screening algorithms to boost their performance may be a future step.embargoed_20200816Smith V, Vanhaecke A, Vandecasteele E, Guerra M, Paolino S, Melsens K, Cutolo M.Smith, V; Vanhaecke, A; Vandecasteele, E; Guerra, M; Paolino, S; Melsens, K; Cutolo, M
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