Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Nailfold Capillary Changes in Patients with Primary Sjogren's Syndrome: Comparison to Controls.
Mishra1, Richa, Shahane1, Anupama, Wu2, Liang, Vivino2, Frederick B.
Nailfold capillaroscopy is a reliable way to distinguish between primary Raynaud's phenomenon (RP) and secondary RP associated with systemic sclerosis (SSc). It's role in the diagnosis of Sjögren's syndrome has not been well characterized. Purpose of this study was to assess prevalence of nailfold capillary changes in patients (pts) with primary Sjögren's syndrome (PSS), non autoimmune sicca controls (chronic sialadenitis) and healthy normal controls, which will help us to determine the utility of this technique for the diagnosis of PSS.
This prospective study was conducted on pts who met the American European Consensus Group (AECG) criteria (Vitali et al, 2002) for PSS (n=61), pts with biopsy proven chronic sialadenitis (n=6) and healthy normal controls (n=35). Healthy normal controls included patients with no sicca symptoms or history of autoimmune disease. Patients with diagnosis of secondary SS were also excluded. All participants filled out medical questionnaires to determine the prevalence of RP, risk factors for cardiovascular disease and other comorbidities. Using a stereo dissecting microscope nailfold capillaries of the 2nd to 5th fingers bilaterally were examined under controlled environmental conditions, photographed and scored.
A semiquantitative rating scale to score each capillary abnormality was adopted (1= Normal, 2= Dilatation >20 and < 50 micrometer, 3= Dilatation >50 micrometer, 4= Hemorrhage, 5= Drop out, 6= Neoangiogenesis). The scores for the eight digits were added together and divided by eight to calculate the total mean capillary score.
A total of 111 patients were included in the study. Nailfold capillaroscopy photmicrographs of 102 patients were analyzed and 9 patients had be excluded because of poor picture quality due to dark skin. Eighty seven % of patients were female.
|Primary Sjögren's syndrome||Chronic sialadenitis||Controls|
|No. of pts||25||36||1||5||2||33|
|Mean Total Score (±SD)||31 (±10)||28.38 (±11)||14||22 (±12)||19 (±2)||13.27 (±9)|
|Mean Total Score of the Group (±SD)||29.45 (±11)||20.6 (±12)||13.6 (±9)|
Patients with PSS had the highest prevalence of RP among all 3 groups and significantly higher mean total capillaroscopy scores compared to healthy controls (p <0.0001) and pts with chronic sialadenitis (p = 0.07). The most common abnormality in PSS was capillary drop out.
The prevalence and severity of nailfold capillary changes in pts with PSS is significantly higher than that of nonautoimmune sicca pts and healthy controls. Capillary changes may occur in the presence or absence of RP. These results suggest that diagnostic sensitivity of AECG classification criteria or other criteria sets for PSS could be further improved by addition of simple variable like nailfold capillaroscopy scores.
To cite this abstract, please use the following information:
Mishra, Richa, Shahane, Anupama, Wu, Liang, Vivino, Frederick B.; Nailfold Capillary Changes in Patients with Primary Sjogren's Syndrome: Comparison to Controls. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :475