Nailfold capillary microscopy in mixed connective tissue disease. Comparison with systemic sclerosis and systemic lupus erythematosus

Abstract

Nailfold capillary microscopy patterns in 22 patients with mixed connective tissue disease (MCTD) were compared with those of 21 patients with systemic lupus erythematosus (SLE) and 30 patients with systemic sclerosis (scleroderma [SD]). Microvascular data were classified blindly as follows: normal, nonspecific abnormalities, SD pattern, and SLE pattern, with special attention to the presence of dystrophic, branched "bushy" capillary formations. Of the 22 patients with MCTD, 63.6% had an SD pattern, 22.7% had an SLE pattern, 13.6% had nonspecific abnormalities, and 72.7% had bushy capillary formations. Compared with SLE microangiopathy, MCTD microangiopathy exhibited significantly greater capillary loss (P < 0.05), more frequent SD patterns (P < 0.001), and more frequent bushy capillaries (P < 0.001). Compared with SD patients, MCTD patients displayed less frequent SD patterns (P < 0.02) and more frequent bushy capillary formations (P < 0.01). The presence of bushy capillaries was suggestive of MCTD. For diagnostic purposes, bushy capillaries displayed 72% sensitivity, 80% specificity, and 87.2% negative predictive value. The quantitative and qualitative expressions of microangiopathy were different in MCTD and SLE, respectively. This supports the hypothesis that each disease is a distinct entity. Nevertheless, there were many resemblances

Mixed connective tissue disease

“…No abnormalities were noted on renal angiogram. Fingernail capillaroscopy indicated that 90% of patients with MCTD had the same pattern of capillary dilation and drop-out as has been reported in SSc (42). In another study, all patients had abnormal nailfold capillaries with patterns similar to those seen in SSc (42).…”

Oral microcirculation observed in vivo by videocapillaroscopy: a review

“…According to these authors, abnormalities consisted of elongated and tiny loops, microhemorrhages, low capillary density, and subpapillary venous plexus visibility alterations. Although they did not seem to be pathognomonic for RA, they do appear to be sufficiently characterised as to differentiate patients with RA from normal controls (34)(35)(36)(37)(38). The hypotheses on the pathogenic mechanism of vascular damage involve the autoantibody and circulating immune complex precipitation in the vessel walls, considered to be the main cause of damage.…”

The Handheld Dermatoscope as a Nail-Fold Capillaroscopic Instrument

“…5,14,15 Nailfold abnormalities constituting an SD pattern have also been demonstrated in 54% to 64% of patients with MCTD, 5,16 in 83% of patients with dermatomyositis, 17 and in only 2.0% to 4.8% of patients with SLE. 5,16 In SLE and dermatomyositis, nonspecific abnormal findings were observed in 24.0% and 13.6% of the patients, respectively, and an "SLE capillaroscopic pattern," defined as torturous meandering capillaries and a prominent subpapillary plexus, was noted in 57.0% and 22.7% of the patients, respectively. 16,18 A recent study using an optical microscope and a video camera with a 60-to 240-fold magnification demonstrated an SD pattern in only 43% of patients with scleroderma and some capillary abnormalities short of an SD pattern in 5% to 15% of the normal controls.…”