ObjectiveNailfold videocapillaroscopy (NVC) allows the detection of microvascular damage in autoimmune connective tissue diseases (CTDs). The prevalence of the morphological capillary findings was retrospectively evaluated in a wide cohort of patients with Raynaud’s phenomenon secondary to a CTD at the time of the first single NVC, independently from their current treatment, autoantibody profile and comorbidities.MethodsOne-thousand-one-hundred-eighty-one patients affected by CTDs were included from 2001 to 2021. The considered CTDs were systemic sclerosis (SSc), undifferentiated connective tissue disease (UCTD), mixed connective tissue disease (MCTD), dermatomyositis (DM), systemic lupus erythematosus, Sjögren’s syndrome and primary antiphospholipid syndrome (aPS). The capillaroscopic parameters were distinguished between scleroderma patterns and non-scleroderma patterns.ResultsGiant capillaries were significantly more frequent in SSc, DM and MCTD than in other CTDs (respectively, in 73%, 73% and 61% of patients, p<0.001 when comparing each rate vs the other CTDs). The mean capillary count was significantly lower in SSc, DM and MCTD (respectively, 7.04±0.18 vs 6.5±0.75 vs 7.7±2 capillaries/linear mm) compared with the other CTDs (p<0.001 for each rate vs the other CTDs). The non-specific abnormalities of capillary morphology were significantly more frequent in SSc, MCTD and aPS (respectively, in 48%, 41% and 36% of cases, all p<0.001 vs each other CTDs).ConclusionThis large size sample of patients with CTDs, collected over 20 years of analysis, confirms the highest prevalence of specific capillaroscopic alterations in patients with SSc, DM and MCTD, when compared with other CTDs.
BackgroundThe temporomandibular disorders (TMDs) encompass a heterogenous group of inflammatory and degenerative diseases which impair the masticatory function causing local pain and dysfunctional consequences of the temporomandibular joint (TMJ) [1].ObjectivesTo systematically review the literature concerning TMDs in immune-mediated rheumatic diseases (IMRDs) of the adult and synthetize their burden in multiple domains of clinical interest: patient-reported outcomes (PROs), frequencies of signs on physical examination, imaging features, histological findings, and risk factors for their development in patients with IMRDs.MethodsA literature search on PubMed Central, Embase and Cochrane Library databases was performed, until June 2022, for studies including TMJ outcomes in IMRDs patients compared with healthy controls, other rheumatic diseases or in the assessed IMRDs patients after follow-up and treatment.Among the IMRDs of the adult, original articles investigating TMJ involvement in inflammatory polyarthritides and/or autoimmune connective tissue diseases were considered.The TMJ outcomes used in clinical studies, the prevalence of TMDs in IMRDs and the risk factors for their development were qualitatively synthetized.The quality of the studies was scored using the Newcastle-Ottawa scale (NOS).ResultsOf the 3259 screened abstracts, 56 papers were included in the systematic review. All of them were evaluated as of fair quality, at least.Most of the papers (77%) investigated TMDs in rheumatoid arthritis (RA) with a prevalence of signs and symptoms varying from 8% to 70%(Table 1).The risk factors for TMDs development in RA were female sex, younger age, anti-citrulline peptide antibodies (ACPA) positivity, higher disease activity, cervical spine involvement, cardiovascular and neuropsychiatric comorbidities(Figure 1).Ten papers (18 %) evaluated TMDs in spondylarthritides (SpA) reporting a prevalence of symptoms and signs in 12%-80% of patients with higher TMDs prevalence in patients with radiographic spine involvement, skin psoriasis and HLADRB1*01 positivity.Among autoimmune connective tissue diseases (CTDs), systemic sclerosis (SSc) displayed the highest evidence of TMDs PROs and clinical findings (20-93%), followed by systemic lupus erythematosus (SLE) in 18-85%, mixed connective tissue disease (MCTD) in 31-63%, primary Sjögren’s syndrome (pSS) in 24-54% and idiopathic inflammatory myopathies (IIMs) in 4-26%.In SSc and SLE, TMDs were more frequent in patients with higher disease activity and duration, correlating with the extent of skin fibrosis in SSc and with renal involvement in SLE.ConclusionTMDs in IMRDs display a significant relevance in the rheumatological clinical practice even if they are often overlooked.This burden is epidemiologically important in terms of PROs and clinical findings which correlate with disease activity in RA, SpA, SSc and SLE.The early recognition and multidisciplinary management of TMDs is warranted and should be aimed at hindering the TMJ structural damage maximizing the quality of life of patients.Reference[1]Covert et al. Diagnostics 2021Table 1.Prevalence of TMJ findings across multiple clinical domains in different IMRDs.IMRD Domains of TMJ involvementRASpASScSLEpSSMCTDIIMsNumber of studies investigating TMJ involvement43/56(77%)10/56(18%)5/56(9%)4/56(7%)4/56(7%)3/56(5%)1/56(2%)Prevalence of TMJ PROs8-70%12-80%20-93%31-66%24-54%31%17-26%Prevalence of TMJ signs on physical examination(i.e., reduced mouth opening)30-54%17-68%44-71%41-85%24-44%50-63%4-13%Imaging findings on X-ray of TMJ50-66%30-38%NA22%NA19%NAImaging findings on computerized tomography of TMJ61-76%NANANANANANAImaging findings on magnetic resonance imaging of TMJ11-95%6-67%67-94%NANA13-93%NAHistological findings of TMJSynovitis and degenerative changesNANANANANANALegenda.NA: not assessed. See the text for the other abbreviations.Figure 1.Risk factors for TMJ involvement in RA, SpA, SSc and SLE (created with biorender.com)Acknowledgements:NIL.Disclosure of InterestsNone Declared.
BackgroundRheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by arthritis and a range of extra-articular organ involvement. Altered microcirculation is an important contributor to the inflammatory reaction characterizing RA and is involved in synovitis and systemic organ manifestations[1]. Nailfold video capillaroscopy (NVC) is a reliable, safe and highly sensitive method for evaluating the morphology of microcirculation and detailed alterations[2].ObjectivesThe objective of the study was to evaluate the microcirculation in adult RA patients by using NVC and to identify morphological and quantifiable NVC parameters with possible correlations with clinical and laboratory findings.MethodsNVC was performed at baseline on 8 fingers of both hands of 25 RA patients (EULAR/ACR 2010 criteria) (mean age 68.57±13.47 years, mean disease duration 14.6±8.6 years)[3]. Different NVC parameters indicating microvascular damage were detected and analyzed, such as microvascular architecture, capillary morphology and loss of capillaries (linear/mm). The results were categorized into “non-scleroderma” pattern, such as “normal” and “non-specific alterations”, as well as “scleroderma” and “scleroderma-like” pattern. The RA patients were treated (at the time of the analysis) with low dose glucocorticoids, NSAIDs and cDMARDs (see Table 1). Statistical analysis was performed by nonparametric tests.ResultsThe patient’s mean age at the time of NVC was 62.68±12.68 years and they consisted mostly of women (84%). The caucasian cohort was composed of 56% seropositive RA patients, all of which were RF positive (100%) and 71.43% also presented anti-CCP positivity. Nine patients (36%) were affected by Raynaud phenomenon.Eighty-four percent of RA patients (84%) presented together with normal capillaries a varying degree of microvascular nonspecific findings, like tortuosity, capillary crossing as well as some abnormal shapes (ramified capillaries).Interestingly, “Early” scleroderma NVC pattern was observed in 1 patient (4%), showing giant capillaries and microhaemorrhages. “Scleroderma-like” capillaroscopic pattern was found in 2 patients (8%) with the following features: dilatations, giant capillaries, microhaemorrhages, abnormal capillary shape with ramifications and reduced mean capillary number per linear mm. NVC observation of “Early” scleroderma pattern and “Scleroderma-like” pattern in 3 patients (12%), suggested the coexistence of an overlap syndrome (most likely MCTD), also supported by clinical and autoantibodies specificities. No specific RA NVC pattern was detectable.No statistically significant correlations were found between different NVC parameters and autoantibodies or specific RA clinical features.ConclusionThe results of present study confirm in sample size that a specific NVC pattern is not detectable in RA, even in early RA patients. The presence of specific patterns, like “Early” scleroderma NCV pattern and “scleroderma-like” pattern, suggest in those “RA patients” the presence of an overlap syndrome. The inclusion of the NVC analysis in patients affected by autoimmune connective tissue diseases (like RA) may contribute to a better definition of the diagnosis, especially in presence of complex clinical symptomatology (overlap syndromes).References[1] Angeloudi E et al. Mediterr J Rheumatol. 2022.[2] Cutolo M et al. Nat Rev Rheumatol. 2021.[3] Aletaha D et al. Arthritis Rheum. 2010.Table 1.Demographic and clinical characteristics of RA patientsn. 25female/male21/4 (5.25:1)current age (years, mean±SD)68.56 (13.47)age at diagnosis (years, mean±SD)53.96 (14.48)seropositive RA14 (56%)FR+14/14 (100%)ACPA+10/14 (71.43%)ANA+7 (28%)ENA+2 (8%)Raynaud phenomenon9 (12%)NVC performed at diagnosis5 (20%)Therapy at NVC baselineNSAIDs2 (8%)glucocorticoids19 (76%)cDMARDs19 (76%)NSAIDs: non-steroidal anti-inflammatory drugs;cDMARDs: conventional disease-modifying antirheumatic drugs.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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