Background/Purpose: The association between disease activity and nailfold capillaroscopy (NC) alterations has been described in systemic lupus erythematosus (SLE). However, data on longitudinal assessment of NC are scarce in childhood-onset SLE (cSLE), especially concerning its association with clinical and laboratory parameters. Therefore, the objectives of this study were to perform a prospective evaluation of nailfold capillaries in childhood-onset SLE (cSLE) and to assess the possible influence of clinical and laboratory manifestations, disease activity and treatment on altered NC.

Methods: This prospective study included cSLE patients regularly followed at the Rheumatology Outpatient clinic, University of Sao Paulo. NC was performed at inclusion and after 18 months and the results were classified as normal (no morphologic alterations and more than 7 loops per linear millimeter) or abnormal (slightly decreased capillary density with the presence of mild to moderate micro-hemorrhages or scleroderma pattern). Clinical and laboratory findings, disease activity score and treatment were evaluated at each NC.

Results:  Forty-four patients were initially included and 33 patients repeated NC after 18 months. Thirty-eight (86%) were female and the median age at baseline was 20.4±3.7 years with mean disease duration of 7.8±4.7 years. Clinical manifestations of lupus since diagnosis included arthritis in 84% of patients, mucocutaneous involvement in 39%, hematologic in 32% and nephritis in 64%. Thirty-eight (86%) patients were positive for anti-dsDNA, 50% anti-Sm, 9% anti-RNP, 39% anti-Ro, 11% anti-La, 52% anti-P and 23% antiphospholipid antibodies. At baseline, the median of SLEDAI was 3.5 (0-16), predominantly for renal activity (30%), leucopenia (14%), positive anti-dsDNA (39%) and hypocomplementemia (45%). Thirty-four (77%) patients were under prednisone, 18% azathioprine, 11% cyclophosphamide, 50% micofenolate mofetil and 11% methotrexate. Comparison of patients with altered and normal NC showed a higher frequency of serositis in the former group (63 vs. 21%, p=0.01), particularly pericarditis (50 vs. 14%, p=0.016), as well as a trend for more cutaneous vasculitis (56 vs. 25%, p=0.054) any time since lupus diagnosis. At baseline, the group with abnormal NC had more mucocutaneous activity (19% vs. 0, p=0.042). No differences were observed in other clinical manifestations, autoantibodies profile, SLEDAI and treatment at the moment of NC (p>0.05). After 18 months, 21/33 (64%) patients maintained the same NC findings and 3/33 (9%) presented new abnormalities or intensified previous alterations. One of the latter also presented new capillary enlargement with a concomitant lupus nephritis, requiring higher doses of immunosuppressive drugs. Among the 9/33 (27%) patients who showed less alterations on NC after 18 months, six had stable disease/SLEDAI and were on prednisone tapering.

Conclusion: This study reinforces the dynamic characteristics of nailfold capillaries in lupus and strengthens the role of NC as a useful tool for the follow-up of cSLE patients, especially concerning disease activity assessment.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/alterations-in-nailfold-capillaroscopy-in-childhood-onset-systemic-lupus-erythematosus-the-role-of-disease-activity-in-a-prospective-study/