Ab0276 nailfold Video Capillaroscopy Support the Diagnosis of Overlap Connective Tissue Disease: A Pilot Study in a Sample of Rheumatoid Arthritis Patients

Abstract

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.