SAT0289\u2005THE ROLE OF CAPILLAROSCOPY IN THE EARLY DIAGNOSIS OF SYSTEMIC SCLEROSIS

Abstract

Background: Systemic Sclerosis is a multisystem autoimmune disease characterized by fibrosis of the skin and internal organs and vascular damage. The diagnosis is usually made in the late stages, when irreversible damage has already occured. Recently, we have established new criteria to detect early cases of the disease. Performing capillaroscopy and its findings are crucial in the diagnosis of early systemic Sclerosis or “prescleroderma” and there may be changes seen in capillaries of patients without skin manifestations. Objectives: To analyze the nailfold capillaroscopy findings in patients with anti-centromere or anti-topoisomerase antibodies and evaluate their usefulness for the diagnosis of systemic sclerosis. Methods: Of a total of 255 capillaroscopy performed in our Rheumatology department, those patients with positive anti-centromere or anti-topoisomerase were selected. In all cases, capillaroscopy was performed in eight fingers, always by the same observer. The following findings were considered pathological or scleroderma pattern: Local or global capillary loss (> 20%), hemorrhages: two or more in at least two fingers and enlarged capillaries: two or more capillary with double or more caliber in at least two different fingers. Statistical analysis was performed with SPSS 19.0 program. Results: The study included 69 patients: 5 (7.2%) males and 64 (92.8%) women, 14 (20.3%) smokers, 47 (68.1%) non-smokers and 8 (11.6%) quitters. The characteristics of the patients included in the study were as follows: 20 patients (30%) were previously diagnosed of systemic sclerosis (19 limited and one diffuse), of which 4 patients had concomitant primary biliary cirrhosis Syndrome (Reynolds), 1 patient with primary biliary cirrhosis and positive anti-centomere without the presence of Raynaud, one patient diagnosed with Sjögren’s syndrome with positive anti-centromere without presence of Raynaud, 26 patients with suspected early systemic sclerosis and 21 patients with disease-specific autoantibodies in the absence of Raynaud. Nailfold capillaroscopy was normal in 32 patients (46.4%) and pathological (scleroderma pattern) in 37 patients (53.6%); we detected limited enlarged capillaries in 26.2%, generalized enlarged capillaries also in 26.2%, giant capillaries in 37.7%, local loss of capillaries in 27.9%, global loss of capillaries in 8.2%, hemorragies in small claims in 29.5% and abundant hemorrhagies in 9.8%. All patients previously diagnosed of systemic sclerosis had a pathological capillaroscopy except one. However, no changes were observed in capillaroscopy in patients who had only disease-specific autoantibodies in the absence of Raynaud’s phenomenon. While, the 26 patients who were referred for suspected systemic sclerosis (at least with the presence of Raynaud and autoantibodies) in 18 (69.9%) of these scleroderma pattern was observed with subsequent diagnosis of early systemic sclerosis or “prescleroderma”. Conclusion: Nailfod capillaroscopy is a useful and inexpensive tool for the diagnosis of systemic sclerosis. The scleroderma pattern is very specific of this disease and we can make an early diagnosis even in patients who only have autoantibodies and Raynaud’s phenomenon, without the presence of other severe manifestations. We have also observed that the absence of Raynaud’s phenomenon is associated with a normal result on capillaroscopy. Reference [1] Nailfold digital capillaroscopic findings in patients with diffuse and limited cutaneous systemic sclerosis. Saeedeh Shenavandeh, Mahyar Yousefipour Haghighi, Mohammad Ali Nazarinia. Reumatologia 2017; 55, 1: 15–23 Disclosure of Interests: None declared