AB0673 CHARACTERISTICS OF THE CAPILLAROSCOPY PATTERN IN SYSTEMIC AUTOIMMUNES DISEASES

Background: Nailfold capillaroscopy (CP) is a simple, safe, low cost and non-invasive screenig test and together with the study of autoantibodies, is useful in the diagnosis of systemic sclerosis (SSc). It demonstrates certain specific patterns which are characterized by the presence of dilated capillaries, haemorrhages and avascular areas. Other systemic autoimmune diseases (SAD) do not have a specific pattern, but certain alterations in the morphology of the capillaries such as increased tortuosity have been described in SLE. In other diseases such as mixed connective tissue disease (MCTD), inflammatory myopathies and overlap syndromes, findings may be different to the pathological findings consistent with scleroderma pattern. Objectives: Description of nailfold capillaroscopic findings in different SAD. Methods: The study included 255 patients referred for CP that was performed in 8 fingers, and always by the same observer. The following findings were considered as “scleroderma pattern”: Local or global capillary loss (> 20%), haemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double caliber or more in at least two different fingers. Abundant evidence of tortuosity (> 20%) as ringlets tangles and no evidence of disorders described above, was considered nonspecific, tortuous pattern or suspects SAD. Statistical analysis was performed with SPSS 19.0 program. Results: CP was performed in 255 patients, 31 males (12%) and 224 (88%) women. 23 patients (9%) had a diagnosis of SSc, 6 patients (2%) of SLE, other 6 (2%) of Sjogren’s syndrome, 7 (3%) of MCTD, 4 (1.5%) of inflammatory myopathy and 2 (0.8%) of overlap syndrome. 18 patients (7%) had positive aNA and Raynaud without another data suggestive of SAD, 76 patinents with primary Raynaud (30%) and 66 patients (26%) with a miscellany of other diseases such as antiphospholipid syndrome, vasculitis, fibromyalgia and psoriatic arthritis. Also, 29 patients (12.4%) were sent for performing CP for suspected systemic sclerosis and 16 patients (6.3%) presented with only positive anti-centromere. CP was normal in 191 patients, while in 45 patients scleroderma pattern was observed and in 19 patients nonspecific pattern suggestive of SAD was seen. Capillaroscopic findings: in each of the 23 patients diagnosed with SSc, 21 patients had scleroderma pattern. Of the 6 patients with SLE, CP was normal in 4 patients, while one patient had abundant tortuosity. Likewise, the 6 patients with Sjogren’s syndrome, only one patient had a nonspecific pattern suggestive of SAD. Of the 7 patients with MCTD, four had normal CP, two had a scleroderma pattern and one had tortuous pattern. The 2 patients with overlap (myopathy-scleroderma and Lupus-scleroderma) both had a pathological CP with scleroderma pattern. Conclusion: Our study demonstrates that the evidence of scleroderma pattern is very specific of SSc. However, in certain diseases such as MCTD, overlap syndromes and inflammatory myopathies, we can also see this pattern. In other SAD, CP is usually normal or may show some nonspecific changes. References: The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Practice & Research Clinical Rheumatology Vol. 21, No. 6, pp. 1093–1108, 2007 Disclosure of interests: None declared