Background/Purpose: Primary antiphospholipid syndrome (PAPS) is characterized by venous and arterial thrombosis, obstetric morbidity and the presence of antiphospholipid antibodies. The utility of nailfold videocapillaroscopy in conditions such as scleroderma (SSc) and primary Raynaud´s phenomenon is well known. Whether patients with PAPS have specific findings in nailfold videocapillaroscopy is not well stablished. Our aim was to evaluate nailfold videocapillaroscopy findings in PAPS patients and their association with clinical and serological features.

Methods: Weincluded 32 PAPS patients according to the modified Sidney criteria and the Alarcón-Segovia criteria for haematologic antiphospholipid syndrome, who regularly attend a tertiary referral center in Mexico City, and 17 healthy controls. We performed nailfold videocapillaroscopy according to the Cutolo technique (Optilia 200x) and obtained: capillary morphology, abnormalities (tortuosity, crossed and dilated capillaries, capillary haemorrhages, neo-angiogenesis) and mean vascular density on 32 images per patient. We collected demographic, clinical (thrombosis, obstetric morbidity, non-criteria manifestations and comorbidities), serological (anticardiolipin antibodies, anti-β2 glycoprotein 1 antibodies and lupus anticoagulant) and treatment information. Analysis was performed used SSPS v.22, Chi square test was used to compare frequencies and Student´s t test was used to compare means.

Results: PAPS patients had higher frequency of at least 1 abnormal finding on videocapillaroscopy (78% vs 12%, p<0.009, OR=26, 95%CI=5-146), higher frequency of dilated capillaries (69% vs 0%, p=0.0001, OR=3.2, 95%CI=1.9-5.3), lower frequency of “perfect normal” pattern (12% vs 59%, p=0.002, OR=0.1, 95%CI=0.02-0.4) than controls, and 8 patients (25%) showed changes compatible with the “early” SSc Cutolo pattern (<4 dilated capillaries/mm, <4 haemorrhages/mm, preserved architecture and no avascular areas). In PAPS patients, capillary haemorrhages were associated with neurologic manifestations (75% vs 14%, p=0.02, OR=19, 95%CI=1.4-248) and with comorbidity with hypertension (75% vs 14%, p=0.02, OR=19, 95%CI=1.4-248), while alterations compatible with “early” pattern were not associated to any clinical or serological variable.

Conclusion: PAPS patients frequently show at least one abnormality on videocapillaroscopy. The most frequent abnormalities are dilated capillaries, microhaemorrhages and the presence of an “atypical normal” pattern. Capillary haemorrages are frequently found in patients with neurologic involvement of PAPS. The coexistence of hypertension or other comorbidities may contribute to the development of capillary abnormalities in PAPS patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-frequency-of-nailfold-videocapillaroscopy-abnormalities-in-primaryantiphospolipid-paps-patients/