Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Time of Transition through Different Patterns of Nailfold Microangiopathy in Systemic Sclerosis.

Sulli1,  Alberto, Pizzorni2,  Carmen, Ravera2,  Francesca, Alessandri2,  Elisa, Zampogna2,  Giuseppe, Seriolo2,  Bruno, Cutolo1,  Maurizio

Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy

Background:

Nailfold microangiopathy is an early aspect of systemic sclerosis (SSc), and its features may be detected by nailfold videocapillaroscopy (NVC). The evolution from "early", to "active", and to "late" patterns of microvascular damage was described by several studies.

Objectives:

To investigate the time of transition through the different patterns of microangiopathy, in SSc patients with the "early" NVC pattern at baseline.

Methods:

Thirty-eight SSc patients (mean age 48±12sd years; mean disease duration from Raynaud's phenomenon onset 10±10 years, from the onset of the first SSc symptom different from RP 1±1 year) with the "early" pattern of nailfold microangiopathy at baseline were followed-up by NVC for a mean time of 90±18 months, every nine months by the same operator. The proper pattern of NVC microangiopathy ("early", "active", "late") was recorded at each visit, as previously reported(1,2). "Early" NVC pattern: few (<33%) giant capillaries, few capillary haemorrhages, relatively well-preserved capillary distribution, no evident loss of capillaries; "active" NVC pattern: frequent (>66%) giant capillaries, frequent capillary haemorrhages, moderate (<33%) loss of capillaries, mild (<33%) disorganisation of the capillary architecture, absent or mild ramified capillaries; "late" NVC pattern: irregular enlargement of the capillaries, few or absent giant capillaries and haemorrhages, severe (>66%) loss of capillaries with avascular areas, disorganisation of the normal capillary array, and ramified/bushy capillaries.

Results:

At the end of the follow-up, 17 patients (43%) were still showing the "early" scleroderma-pattern, while the NVC pattern of microangiopathy was changed in 57% of the patients. The NVC pattern was found "active" in 14 patients (38%), "late" in 5 patients (14%), and normal in 2 patients (5%). The mean time of progression from the "early" to the "active" pattern was of 28±20 months, and from the "early" to the "late" pattern it was of 36±29 months. Interestingly, in the subgroup of patients whose microangiopathy progressed from the "early" to the "late" NVC pattern through the "active" pattern, the mean time of progression from the "early" to the "active" pattern was only 8±1 months, discovering a subset of SSc patients (14%) with fast progression of SSc microangiopathy.

Conclusions:

The results of this longitudinal study confirm the transition of the SSc microvascular damage through different NVC patterns of microangiopathy. Fourteen % of SSc patients progressed quickly to "late" from "early" NVC pattern of microangiopathy. Patients showing a fast progression from the "early" to the "active" NVC pattern of microangiopathy should be strictly monitored as at risk of rapid progression to the "late" NVC pattern of microvascular damage, characterized by capillary desertification and disorganization.

References:

1.Cutolo, M, et al. Rheumatology 2004; 43:719–26.

2.Cutolo, M, et al. Best Pract Res Clin Rheumatol 2008; 22:1093–108.

To cite this abstract, please use the following information:
Sulli, Alberto, Pizzorni, Carmen, Ravera, Francesca, Alessandri, Elisa, Zampogna, Giuseppe, Seriolo, Bruno, et al; Time of Transition through Different Patterns of Nailfold Microangiopathy in Systemic Sclerosis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1236
DOI: 10.1002/art.29002

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