Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


A Two Year Prospective Study of Changes in Nailfold Capillary Architecture in Primary and Secondary Raynauds Phenomenon

Herrick1,  Ariane L., Moore1,  Tonia L., Murray1,  Andrea K., Vail1,  Andy, Taylor2,  Christopher J.

University of Manchester, Salford Royal Hospital, Salford, United Kingdom,
University of Manchester, United Kingdom

Purpose:

Recent advances in nailfold capillaroscopy, including high magnification videocapillaroscopy and the ability to track change over time, allow non-invasive and detailed analysis of the abnormal capillary morphology which is a characteristic feature of systemic sclerosis [SSc]-spectrum disorders. We have developed software to allow automated measurements of microvessel architecture (width, intercapillary distance, tortuosity and derangement). The time period over which SSc-related microvascular derangement evolves is not currently known. The aim of this prospective study was to assess changes in nailfold capillary architecture over 2 years in different subgroups of patients with Raynaud's phenomenon.

Method:

26 healthy controls, 10 patients with primary Raynaud's phenomenon, 13 patients with undifferentiated connective tissue disease, 15 patients with diffuse cutaneous SSc and 80 patients with limited cutaneous SSc were studied at baseline and at 24 months. Their mean age was 53 years, range 20 to 84 years. 119 (83%) were female. Following acclimatisation for 20 minutes at room temperature (23°C), the ring finger of the non-dominant hand was imaged with video microscopy at 300x magnification. Measurements were made using the automated analysis programme to give measures of capillary width, intercapillary distance, tortuosity (curliness) and derangement (variation in dominant direction of capillaries).

Results:

Results for the 5 capillary measurements (4 automated) are summarised in the table. The P-value relates to non-parametric before-and-after testing excluding controls.

Measurement (all arbitrary units)Baseline Median (IQR)24 months Median (IQR)p-value
Automated intercapillary distance*25312 16851 to 4647530289 18852 to 566660.005
Width13.8 11.5 to 15.712.5 10.4 to 15.10.0001
Derangement11.68.6 to 16.411.0 8.3 to 15.40.05
Tortuosity3.26 3.15 to 3.343.23 3.12 to 3.320.04
Manual distance*113 94 to 150116 95 to 1660.06
* analysed on log scale

These results show that for all measurements (except manually measured distance, p= 0.06) there was significant change over two years: intercapillary distance increased, whereas width, derangement and tortuosity all fell over 2 years. Non-parametric group comparison of change scores showed no evidence that the size of the change varied between subject subgroups (although subgroups were small).

Conclusion:

1. Capillary morphology changes over 2 years in patients with Raynaud's phenomenon, lending further support for nailfold capillaroscopy as an outcome measure in long-term clinical trials.

2. The increase in intercapillary distance suggests disease progressed across the different subgroups.

3. The fall in width, derangement and tortuosity were not anticipated and these require further assessment as outcome measures.

To cite this abstract, please use the following information:
Herrick, Ariane L., Moore, Tonia L., Murray, Andrea K., Vail, Andy, Taylor, Christopher J.; A Two Year Prospective Study of Changes in Nailfold Capillary Architecture in Primary and Secondary Raynauds Phenomenon [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1731
DOI: 10.1002/art.26805

Abstract Supplement

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