The usefulness of capillaroscopy for assessment of microcirculation disturbances during treatment

Capillaroscopy is a non-invasive method enabling the assessment of microcirculation in patients with Raynaud`s phenomenon. The examination has been used for early diagnosis of systemic sclerosis and diseases from the scleroderma spectrum and for assessment of systemic sclerosis activity as well as for monitoring and evaluation of the efficacy of therapy. Vasodilators applied in the treatment of vascular disorders during systemic sclerosis were demonstrated to significantly improve the capillaroscopy images, expressed as an increased number of capillaries and reduced disorganisation of vascular drawings. Forum Reumatol. 2019, tom 5, nr 2: 65–6

Capillaroscopic examination in the early diagnosis of systemic sclerosis

Systemic sclerosis (SSc) is a connective tissue disease characterised by impairment of vascular function. One of the examinations particularly useful in the early diagnosis of SSc is nail fold capillaroscopy. In SSc, the capillaroscopic findings show characteristic microcirculatory disorders defined as SSc-associated microangiopathy. The term microangiopathy includes the following pathological changes: decreased numbers of vessels with areas of avascularisation, widened vascular loops leading to the formation of megacapillaries, the presence of ramified loops and cap-shaped microextravasations. The important pathological changes occurring already in the early forms of SSc are megacapillaries Apart from early diagnosis, capillaroscopy is of prognostic importance, as the type of capillaroscopic lesions may correlate with disease activity and the degree of involvement of internal organs. In addition, capillaroscopy is used to monitor the course of SSc and the response to treatment

Osteoporosis treatment with denosumab in routine clinical practice in Poland

Introduction: The receptor activator for nuclear factor k B ligand (RANKL) inhibitor denosumab is approved for the treatment of osteoporosis in postmenopausal women and men at increased fracture risk. The objectives were to describe the characteristics of patients with osteoporosis initiating denosumab in Polish clinical practice and their clinical management during the first 12 months of denosumab treatment. Material and methods: This prospective, observational study enrolled denosumab-naïve women and men in Poland with osteoporosis, who had received at least one denosumab injection in the 8 weeks prior to enrolment. Patients were enrolled from specialist osteoporosis treatment centres, and orthopaedic, rheumatological, and family doctor centres. Outcomes included patient characteristics, denosumab treatment patterns, bone mineral density (BMD), and fracture; all analyses were descriptive. Results: The study enrolled 463 patients; most (96%) were women, aged ≥ 65 years (84%), with prior fractures (88%). Approximately two-thirds of the women had received prior osteoporosis therapy, with the main reasons for discontinuation being adverse events (75%) and lack of effect (73%). Across all patients, the most common reasons for prescribing denosumab were low bone mineral density (BMD/T-score) (93%) and history of osteoporotic fracture (78%). Mean BMD at denosumab initiation ranged from T-score –3.00 (lumbar spine) to T-score –2.6 (total hip), and BMD increased by 2.8–6.2% at month 12. Most patients completed follow-up (86%) and were due to receive a third denosumab injection (81%). Conclusion: The article presents detailed sociodemographic and disease-related characteristics of patients who routinely implemented denosumab therapy. Most of them continued denosumab for at least 12 months, with increased BMD T-scores

Badanie kapilaroskopowe we wczesnej diagnostyce twardziny układowej

Twardzina układowa (SSc, systemic sclerosis) jest chorobą tkanki łącznej, która charakteryzuje się upośledzeniem funkcji naczyń krwionośnych. Jednym z badań szczególnie przydatnych we wczesnej diagnostyce SSc jest kapilaroskopia wałów paznokciowych. Jej wyniki u pacjentów z SSc ujawniają charakterystyczne zaburzenia mikrokrążenia określane jako mikroangiopatia związana z twardziną układową. Termin mikroangiopatia obejmuje następujące zmiany patologiczne: zmniejszoną liczbę naczyń z obszarami awaskularyzacji, poszerzone pętle naczyniowe prowadzące do powstawania megakapilar, obecność rozgałęzionych pętli i wynaczynień czapeczkowatych. Ważnymi zmianami patologicznymi występującymi już we wczesnych postaciach SSc są megakapilary. Oprócz wczesnej diagnozy kapilaroskopia ma znaczenie prognostyczne, ponieważ rodzaj zmian kapilaroskopowych może korelować z aktywnością choroby i stopniem zajęcia narządów wewnętrznych. Ponadto kapilaroskopia jest wykorzystywana do monitorowania przebiegu SSc i odpowiedzi na leczenie

Coexistence of diabetes mellitus type 1 with diffuse systemic sclerosis – case report and literature review

Diabetic sclerodactyly is a frequently recognized skin finding that may occur in patients with diabetes mellitus but coexistence of diabetes and systemic sclerosis is rare. We describe a case of coexistence of type 1 diabetes mellitus and systemic sclerosis in 42-year-old man with the history of Raynaud’s phenomenon, progressive diffuse hardening of the skin and sclerodactyly, slowly worsening with time. The medical history included type 1 diabetes since childhood with microvascular complications. The patient presented a typical capillaroscopic scleroderma-like pattern, antinuclear antibodies and sclerotic lesions in gastrointestinal system. Summing up, our case represents the rare coexistence of autoimmune diseases like diabetes mellitus type 1 and systemic sclerosis

Influence of antiphospholipid antibody positivity on glomerular filtration rate markers in a group of systemic sclerosis patients – a 24-month observation

Aim of the study: The aim of the study was the assessment of changes in the glomerular filtration rate (GFR) during long-term observation in a group of systemic sclerosis (SSc) patients with and without chronic antiphospholipid (aPL) antibody positivity. Material and methods: The observation comprised 50 patients – 23 with diffuse cutaneous SSc – dcSSc and 27 limited cutaneous SSc – lcSSc. After 24 months we assessed 27 patients (9 died, 14 lost follow up); 24 patients (88%) were treated chronically with angiotensin-converting-enzyme inhibitors (ACEIs). Patients were investigated for the presence of aPL: to cardiolipin and to 2 glycoprotein I in IgM and IgG classes. Serum levels of creatinine (S-Cr), cystatin C and creatinine clearance values were determined in all patients. According to the presence of a significant level of at least one of aPL antibodies, pts were divided into groups: group I aPL positive: 14 patients, group II aPL negative – 13 patients. Results: We did not find significant differences in S-Cr, cystatin C levels and creatinine clearance before and after 24 months of observation between both groups. In follow up observations, the presence of anti-centromere antibodies was significantly more frequent in the aPL positive, as compared to the aPL negative group (p = 0.01). In follow up observations, the level of anticardiolipin antibodies in IgG class was significantly higher in dcSSc compared to lcSSc patients (p = 0.02). Conclusions: In long-term observation chronic positivity for aPL antibodies does not significantly decrease the GFR in patients with SSc treated with ACEIs