Advertisement

Clinical Rheumatology

, Volume 37, Issue 10, pp 2723–2729 | Cite as

Long-term follow-up of nailfold videocapillaroscopic changes in dermatomyositis versus systemic sclerosis patients

  • C. Pizzorni
  • M. Cutolo
  • A. Sulli
  • B. Ruaro
  • A. C. Trombetta
  • G. Ferrari
  • G. Pesce
  • V. Smith
  • S. Paolino
Original Article
  • 102 Downloads

Abstract

To identify nailfold videocapillaroscopy (NVC) changes in patients with dermatomyositis (DM) during a 3-year follow-up and to compare the NVC findings between DM and systemic sclerosis (SSc) patients at their first visit. Retrospective study of 24 DM and 24 SSc patients, matched for age and disease duration at first NVC. Capillaroscopic patterns/scores and clinical parameters had been yearly assessed. Nineteen out of 24 DM patients (79%) showed a NVC “scleroderma-like pattern.” No statistically significant variation of all the capillaroscopic scores was observed during the 3-year follow-up. By comparing DM patients with or without anti-Jo-1 positivity, no statistically significant difference of the scores of the main capillary parameters was observed at baseline between the groups. Comparing at baseline DM with SSc patients, the giant capillary and microhemorrhage scores were significantly higher in SSc than those in DM patients (p = 0.04 and p = 0.05, respectively), while capillary density, ramification (abnormally shaped capillaries, expression of angiogenesis), and disorganization scores were higher in DM patients (p = 0.05, p = 0.002, p = 0.004, respectively). The absolute number of ramified capillaries was significantly higher in DM patients (p = 0.002), while the absolute capillary number was significantly higher in SSc patients (p = 0.05) at baseline. This pilot study demonstrates, for the first time, over long-term, that the capillaroscopic manifestations of DM persist in contrast to the progressive changes described in SSc patients, and the anti-Jo-1 positivity does not seem to modify the NVC pattern.

Keywords

Anti-Jo1 antibodies Dermatomyositis Microcirculation Nailfold capillaroscopy Systemic sclerosis 

Notes

Acknowledgments

M. Cutolo, C. Pizzorni, B. Ruaro, V. Smith, and A. Sulli are members of the EULAR study group on microcirculation in rheumatic diseases.

Compliance with ethical standards

Disclosures

None.

Ethical standards

This retrospective study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments, and was evaluated from the local IRB.

References

  1. 1.
    Plotz PH, Rider LG, Targoff IN, Raben N, O'Hanlon TP, Miller FW (1995) Myositis: immunologic contributions to understanding cause, pathogenesis, and therapy. Ann Intern Med 122:715–724CrossRefPubMedGoogle Scholar
  2. 2.
    Dalakas MC (2015) Inflammatory muscle diseases. N Engl J Med 372:1734–1747CrossRefPubMedGoogle Scholar
  3. 3.
    Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Torre IG, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O’Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG, International Myositis Classification Criteria Project consortium, The Euromyositis register and The Juvenile Dermatomyositis Cohort Biomarker Study and Repository (JDRG) (UK and Ireland) (2017) 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 76:1955–1964CrossRefPubMedGoogle Scholar
  4. 4.
    Ghirardello A, Bassi N, Palma L, Borella E, Domeneghetti M, Punzi L, Doria A (2013) Autoantibodies in polymyositis and dermatomyositis. Curr Rheumatol Rep 15:335CrossRefPubMedGoogle Scholar
  5. 5.
    Mahler M, Fritzler MJ (2010) Epitope specificity and significance in systemic autoimmune diseases. Ann N Y Acad Sci 1183:267–287CrossRefPubMedGoogle Scholar
  6. 6.
    Cutolo M, Sulli A, Secchi ME, Olivieri M, Pizzorni C (2007) The contribution of capillaroscopy to the differential diagnosis of connective autoimmune diseases. Best Pract Res Clin Rheumatol 21:1093–1108CrossRefPubMedGoogle Scholar
  7. 7.
    Cutolo M, Sulli A, Pizzorni C, Accardo S (2000) Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis. J Rheumatol 27:155–160PubMedGoogle Scholar
  8. 8.
    Cutolo M, Melsens K, Herrick AL, Foeldvari I, Deschepper E, De Keyser F, EULAR Study Group on Microcirculation in Rheumatic Diseases et al (2018) Reliability of simple capillaroscopic definitions in describing capillary morphology in rheumatic diseases. Rheumatology (Oxford) 57:757–759CrossRefGoogle Scholar
  9. 9.
    Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, EULAR study group on microcirculation et al (2016) An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. Rheumatology (Oxford) 55:883–890CrossRefGoogle Scholar
  10. 10.
    Selva-O’Callaghan A, Fonollosa-Pla V, Trallero-Araguás E, Martínez-Gómez X, Simeon-Aznar CP, Labrador-Horrillo M, Vilardell-Tarrés M (2010) Nailfold capillary microscopy in adults with inflammatory myopathy. Semin Arthritis Rheum 39:398–404CrossRefPubMedGoogle Scholar
  11. 11.
    Mugii N, Hasegawa M, Matsushita T, Hamaguchi Y, Horie S, Yahata T et al (2011) Association between nail-fold capillary findings and disease activity in dermatomyositis. Rheumatology (Oxford) 250:1091–1098CrossRefGoogle Scholar
  12. 12.
    Manfredi A, Sebastiani M, Cassone G, Pipitone N, Giuggioli D, Colaci M, Salvarani C, Ferri C (2015) Nailfold capillaroscopic changes in dermatomyositis and polymyositis. Clin Rheumatol 34:279–284CrossRefPubMedGoogle Scholar
  13. 13.
    Smith V, Pizzorni C, de Keyser F, Decuman S, Van Praet JT, Deschepper E, Sulli A et al (2010) Reliability of the qualitative and semiquantitative nailfold videocapillaroscopy assessment in a systemic sclerosis cohort: a two-centre study. Ann Rheum Dis 69:1092–1096CrossRefPubMedGoogle Scholar
  14. 14.
    Dalakas MC, Hohlfeld R (2003) Polymyositis and dermatomyositis. Lancet 362:971–982CrossRefPubMedGoogle Scholar
  15. 15.
    Huber A, Feldman BM (2013) An update on inflammatory myositis in children. Curr Opin Rheumatol 25:630–635CrossRefPubMedGoogle Scholar
  16. 16.
    Feldman BM, Rider LG, Reed AM, Pachman LM (2008) Juvenile dermatomyositis and other idiopathic inflammatory myopathies of childhood. Lancet 371:2201–2212CrossRefPubMedGoogle Scholar
  17. 17.
    Mercer LK, Moore TL, Chinoy H, Murray AK, Vail A, Cooper RG, Herrick AL (2010) Quantitative nailfold video capillaroscopy in patients with idiopathic inflammatory myopathy. Rheumatology (Oxford) 49:1699–1705CrossRefGoogle Scholar
  18. 18.
    Manfredi A, Sebastiani M, Campomori F, Pipitone N, Giuggioli D, Colaci M, Praino E, Ferri C (2016) Nailfold videocapillaroscopy alterations in dermatomyositis and systemic sclerosis: toward identification of a specific pattern. J Rheumatol 43:1575–1580CrossRefPubMedGoogle Scholar
  19. 19.
    Van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A et al (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 72:1747–1755CrossRefPubMedGoogle Scholar
  20. 20.
    Cutolo M, Sulli A, Smith V (2013) How to perform and interpret capillaroscopy. Best Pract Res Clin Rheumatol 27:237–248CrossRefPubMedGoogle Scholar
  21. 21.
    De Angelis R (2010) The most important capillaroscopic parameters in normal and pathological conditions. In: Cutolo M (ed) Atlas of capillaroscopy in rheumatic diseases, vol I. Elsevier, Milan, pp 61–69Google Scholar
  22. 22.
    Cutolo M, Sulli A, Smith V (2010) Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol 6:578–587CrossRefPubMedGoogle Scholar
  23. 23.
    Sulli A, Secchi ME, Pizzorni C, Cutolo M (2008) Scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients. Ann Rheum Dis 67:885–887CrossRefPubMedGoogle Scholar
  24. 24.
    Dobloug C, Garen T, Bitter H, Stjärne J, Stenseth G, Grøvle L, Sem M, Gran JT, Molberg Ø (2015) Prevalence and clinical characteristics of adult polymyositis and dermatomyositis; data from a large and unselected Norwegian cohort. Ann Rheum Dis 74:1551–1556CrossRefPubMedGoogle Scholar
  25. 25.
    Bergman R, Sharony L, Schapira D, Nahir MA, Balbir-Gurman A (2003) The handheld dermatoscope as a nail-fold capillaroscopic instrument. Arch Dermatol 139:1027–1030CrossRefPubMedGoogle Scholar
  26. 26.
    Mugii N, Hasegawa M, Hamaguchi Y, Tanaka C, Kaji K, Komura K, Ueda-Hayakawa I, Horie S, Ikuta M, Tachino K, Ogawa F, Sato S, Fujimoto M, Takehara K (2009) Reduced red blood cell velocity in nail-fold capillaries as a sensitive and specific indicator of microcirculation injury in systemic sclerosis. Rheumatology (Oxford) 48:696–703CrossRefGoogle Scholar
  27. 27.
    Bertolazzi C, Cutolo M, Smith V, Gutierrez M (2017) State of the art on nailfold capillaroscopy in dermatomyositis and polymyositis. Semin Arthritis Rheum 47:432–444CrossRefPubMedGoogle Scholar
  28. 28.
    Trombetta AC, Smith V, Pizzorni C, Meroni M, Paolino S, Cariti C, Ruaro B, Sulli A, Cutolo M (2016) Quantitative alterations of capillary diameter have a predictive value for development of the capillaroscopic systemic sclerosis pattern. J Rheumatol 43:599–606CrossRefPubMedGoogle Scholar
  29. 29.
    Ingegnoli F, Ardoino I, Boracchi P, Cutolo M, EUSTAR co-authors (2013) Nailfold capillaroscopy in systemic sclerosis: data from the EULAR scleroderma trials and research (EUSTAR) database. Microvasc Res 89:122–128CrossRefPubMedGoogle Scholar
  30. 30.
    Cutolo M, Herrick AL, Distler O, Becker MO, Beltran E, Carpentier P, CAP Study Investigators et al (2016) Nailfold videocapillaroscopic features and other clinical risk factors for digital ulcers in systemic sclerosis: a multicenter, prospective cohort study. Arthritis Rheumatol 68:2527–2539CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Cutolo M, Sulli A, Secchi ME, Paolino S, Pizzorni C (2006) Nailfold capillaroscopy is useful for the diagnosis and follow-up of autoimmune rheumatic diseases. A future tool for the analysis of microvascular heart involvement? Rheumatology (Oxford) 45:iv43–iv46CrossRefGoogle Scholar
  32. 32.
    De Angelis R, Cutolo M, Gutierrez M, Bertolazzi C, Salaffi F, Grassi W (2012) Different microvascular involvement in dermatomyositis and systemic sclerosis. A preliminary study by a tight videocapillaroscopic assessment. Clin Exp Rheumatol 30:S67–S70PubMedGoogle Scholar
  33. 33.
    Riccieri V, Vasile M, Macri V, Sciarra I, Stefanantoni K, De Luca N et al (2010) Successful immunosuppressive treatment of dermatomyositis: a nailfold capillaroscopy survey. J Rheumatol 37:443–445CrossRefPubMedGoogle Scholar
  34. 34.
    Cutolo M, Ruaro B, Pizzorni C, Ravera F, Smith V, Zampogna G, Paolino S, Seriolo B, Cimmino M, Sulli A (2014) Longterm treatment with endothelin receptor antagonist bosentan and iloprost improves fingertip blood perfusion in systemic sclerosis. J Rheumatol 41:881–886CrossRefPubMedGoogle Scholar
  35. 35.
    Trombetta AC, Pizzorni C, Ruaro B, Paolino S, Sulli A, Smith V, Cutolo M (2016) Effects of longterm treatment with bosentan and iloprost on nailfold absolute capillary number, fingertip blood perfusion, and clinical status in systemic sclerosis. J Rheumatol 43:2033–2041CrossRefPubMedGoogle Scholar
  36. 36.
    Filaci G, Cutolo M, Scudeletti M, Castagneto C, Derchi L, Gianrossi R et al (1999) Cyclosporin A and iloprost treatment of systemic sclerosis: clinical results and interleukin-6 serum changes after 12 months of therapy. Rheumatology (Oxford) 38:992–996CrossRefGoogle Scholar
  37. 37.
    Aschwanden M, Daikeler T, Jaeger KA, Thalhammer C, Gratwohl A, Matucci-Cerinic M, Tyndall A (2008) Rapid improvement of nailfold capillaroscopy after intense immunosuppression for systemic sclerosis and mixed connective tissue disease. Ann Rheum Dis 67:1057–1059CrossRefPubMedGoogle Scholar
  38. 38.
    Burmester GR, Bijlsma JWJ, Cutolo M, McInnes IB (2017) Managing rheumatic and musculoskeletal diseases—past, present and future. Nat Rev Rheumatol 13:443–448CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • C. Pizzorni
    • 1
  • M. Cutolo
    • 1
  • A. Sulli
    • 1
  • B. Ruaro
    • 1
  • A. C. Trombetta
    • 1
  • G. Ferrari
    • 1
  • G. Pesce
    • 2
  • V. Smith
    • 3
  • S. Paolino
    • 1
  1. 1.Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, San Martino Polyclinic HospitalUniversity of GenovaGenoaItaly
  2. 2.Autoimmunity Laboratory, Department of Internal Medicine, San Martino Polyclinic HospitalUniversity of GenovaGenoaItaly
  3. 3.Department of Rheumatology, Ghent University Hospital, Department of Internal MedicineGhent UniversityGhentBelgium

Personalised recommendations