Background/Purpose: Nailfold capillaroscopy (NC) has been demonstrated to be an important tool in the treatment of patients with juvenile dermatomyositis (JDM) and systemic sclerosis. However, NC has been scarcely studied in adult patients with DM. Therefore we analyzed NC specifically in adult patients with early onset-DM and also evaluated the possible correlation between NC abnormalities and clinical and activity parameters of DM.

Methods: The present cross-sectional single-center study included 39 consecutive adult patients with early onset-DM (Bohan & Peter, 1975) followed in our Rheumatology outpatient clinic. The early onset was defined as DM diagnosis up to 24 months. We excluded patients with diabetes mellitus, malignancy associated-DM, amyopathic DM or other autoimmune diseases. The NC was performed using Olympus^®stereomicroscope. A semiquantitative rating scale was used to score capillaroscopy changes. Myositis disease activity assessment tools were used to assess disease activity [Manual Muscle Testing (MMT), Myositis Disease Activity Assessment Visual Analogue Scales (MYOACT), Health Assessment Questionnaire (HAQ), physician’s VAS, patient’s VAS, serum muscle enzymes levels].

Results: The median age of patients was 42.0 (interquartile range: 36.0-55.0) years, with 69.2% Caucasian and 71.8% female gender. The median time of DM diagnosis was 1.0 (0.0-1.0) year, whereas the time duration between symptoms onset and DM diagnosis was 4.0 (3.0-12.0) months. The results presented median value of 75 (62-80) for MMT, 1.00 (0.13-2.41) for HAQ, 4.5 (3.0-5.8) cm for physician’s VAS, 5.0 (2.0-6.0) cm for patient’s VAS, 11 (6-21) for MYOACT, 174 (95-598) U/L for creatine kinase and 6.0 (3.8-12.0) U/L for aldolase. Concerning treatment, 92.3% were using prednisone 40 (10-60) mg/day and 76.2% at least one immunosuppressive drug. Thirty-two (82.1%) patients had scleroderma capillary (SD)-like pattern in the NC [density of 6.2 (4.0-7.6) capillaries/mm; 43.6% with severe avascular areas; 15.4% with high degree of micro-hemorrhages; 87.2% with bushy capillaries; 87.2% with dilated capillaries; 61.5% with giant capillaries, 89.7% with neoangiogenesis). The SD-like pattern correlated positively with HAQ, patient’s and physician’s VAS. The capillary density correlated positively with “shawl” sign, patient’s and physician’s VAS, whereas the neoangiogenesis correlated positively with patient’s VAS, MMT, HAQ and serum creatine kinase levels (P<0.05). The micro-hemorrhages correlated negatively with pulmonary involvement, while dose of prednisone correlated negatively with SD-like pattern (P<0.05). No significant correlations between NC and other demographic, clinical and laboratory parameters were observed. 

Conclusion: Similarly to JDM, the NC may provide helpful information about patients with early onset-DM by: (a) contributing to an early diagnosis and (b) correlating with disease activity parameters. Additional investigations with larger series of patients and prospective studies may be useful to reinforce our data.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nailfold-capillaroscopy-in-patients-with-early-onset-dermatomyositis/