Background/Purpose: There is currently no study in newly onset dermatomyositis (DM) regarding nailfold capillaroscopy (NC) findings, angiogenic cytokines, disease related clinical, laboratory and treatment features. Therefore, the aims of the present study were: (a) to analyze cross-sectionally and prospectively NC findings in newly onset-DM; (b) to correlate NC findings with serum angiogenic cytokines [angiogenin (ANG), vascular endothelial growth factor-1 (VEGF1)] and DM clinical and laboratory features.

Methods: Twenty-three patients with DM with less than 12 months of symptoms were included. All the patients met at least four of the five criteria of Bohan and Peter criteria, including classical cutaneous lesions (heliotrope rash and/or Gottron’s papules) and the new European League Against Rheumatism / American College of Rheumatology (EULAR / ACR) classification criteria for DM. To assess serum cytokine levels, age, gender and ethnicity-matched 23 healthy volunteers were recruited as a control group. NC characteristics and DM activity parameters were analyzed. Additionally, 15 out of 23 patients were also assessed prospectively after a median duration of 3.21 years.

Results: A significantly higher serum ANG and VEGF1 levels (P=0.017 and P<0.001, respectively) were observed in DM patients compared to controls. Capillary density and avascular areas correlated positively (r=0.6; P=0.016) and negatively (r=-0.59; P=0.019) with serum level of ANG. Besides, capillary density correlated inversely with the number of enlarged (r=-0.54; P=0.007); giant capillaries (r=-0.53; P=0.009) and avascular areas (r=-0.84; P<0.001). The number of the enlarged capillaries correlated positively with patient (r=0.49; P=0.016) and physician VAS (r=0.56; P=0.005), presence of facial rash (r=0.44; P=0.035), giant capillaries (r=0.76; P=<0.001) and microhemorrhages (r=0.59; P=0.003). Giant capillaries had positive correlation with physician (r=0.50; P=0.014) and cutaneous VAS (r=0.42; P=0.046), enlarged capillaries (r=0.76; P<0.001), avascular areas (r=0.54; P=0.007), microhemorrhages (r=0.55; P=0.006) and bushy capillaries (r=0.42; P=0.044) and negative with capillary density (r=-0.53; P=0.009). Microhemorrhages correlated positively with “V-neck” sign (r=0.44; P=0.032) and physician VAS (r=0.48; P=0.02). VEGF1 showed no relation to NC parameters neither with DM-related clinical and laboratory features. Longitudinally, all patients had major clinical response with significant improvement in the all NC parameters, except for enlarged and bushy capillaries.

Conclusion: The present data emphasize that NC may be a useful tool to assess disease activity in recently onset-DM and also reinforce the role of ANG in the angiogenesis process in this myopathy.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/nailfold-capillary-changes-in-the-adult-newly-onset-dermatomyositis-a-prospective-cohort-study/